Basic Information
| Provider Information | |||||||||
| NPI: | 1225504798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | VALORIE | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | QMHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3647 HIGHWAY 39 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976032612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418845244 | ||||||||
| FaxNumber: | 5418878184 | ||||||||
| Practice Location | |||||||||
| Address1: | 3647 HIGHWAY 39 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976032612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418845244 | ||||||||
| FaxNumber: | 5418878184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | Y | Nursing Service Related Providers | Technician | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.