Provider Demographics
NPI:1003002437
Name:BROWN, SALLY ROSS
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ROSS
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15449C FOREST BLVD N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-7329
Mailing Address - Country:US
Mailing Address - Phone:651-426-1548
Mailing Address - Fax:651-653-9444
Practice Address - Street 1:15449C FOREST BLVD N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-7329
Practice Address - Country:US
Practice Address - Phone:651-426-1548
Practice Address - Fax:651-653-9444
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies