Individual
KICONYA BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
7650 N 43RD AVE, GLENDALE, AZ 85301-1661
(623) 435-6033
Mailing address
7650 N 43RD AVE, GLENDALE, AZ 85301-1661
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP051072
AZ
Other
Enumeration date
08/24/2015
Last updated
08/24/2015
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