Provider Demographics
NPI:1114289295
Name:BROWN, ANDRENA VERNESSA (LPN)
Entity Type:Individual
Prefix:
First Name:ANDRENA
Middle Name:VERNESSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2758 SCHLEIGEL BLVD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1341
Mailing Address - Country:US
Mailing Address - Phone:631-805-0068
Mailing Address - Fax:
Practice Address - Street 1:2758 SCHLEIGEL BLVD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1341
Practice Address - Country:US
Practice Address - Phone:631-805-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310054-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse