Provider Demographics
NPI:1083806194
Name:BROWN, ETHEL LOUISE (BSN)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:LOUISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 E 52ND ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1528
Mailing Address - Country:US
Mailing Address - Phone:317-259-4996
Mailing Address - Fax:317-259-4996
Practice Address - Street 1:3135 E 52ND ST
Practice Address - Street 2:UNIT B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1528
Practice Address - Country:US
Practice Address - Phone:317-259-4996
Practice Address - Fax:317-259-4996
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28132436A163W00000X
IN28113236A163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)