Provider Demographics
NPI:1083939235
Name:BROWN FREEMAN, EBONI (CRNP)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:BROWN FREEMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GETTY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2161
Mailing Address - Country:US
Mailing Address - Phone:201-665-3066
Mailing Address - Fax:973-200-8137
Practice Address - Street 1:600 GETTY AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2161
Practice Address - Country:US
Practice Address - Phone:201-665-3066
Practice Address - Fax:973-200-8137
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSP010648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health