Provider Demographics
NPI:1043416183
Name:BROWN, LINDA LOU (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOU
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:LOU
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:10809 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:HUNT
Mailing Address - State:NY
Mailing Address - Zip Code:14846-9607
Mailing Address - Country:US
Mailing Address - Phone:585-567-8158
Mailing Address - Fax:585-567-4107
Practice Address - Street 1:10809 DAVIS RD
Practice Address - Street 2:
Practice Address - City:HUNT
Practice Address - State:NY
Practice Address - Zip Code:14846-9607
Practice Address - Country:US
Practice Address - Phone:585-567-8158
Practice Address - Fax:585-567-4107
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236164-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02738365Medicaid