Provider Demographics
NPI:1003253519
Name:BROWN, BARBARA (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29114-0628
Mailing Address - Country:US
Mailing Address - Phone:843-396-4457
Mailing Address - Fax:843-396-9512
Practice Address - Street 1:312 N. JONES ROAD
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114-0628
Practice Address - Country:US
Practice Address - Phone:843-396-4457
Practice Address - Fax:843-396-9512
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1245288901Medicaid