Provider Demographics
NPI:1114445780
Name:BROWN, NATHANIEL MICHAEL SR
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:MICHAEL
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 SUMRALL DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-6051
Mailing Address - Country:US
Mailing Address - Phone:225-276-4408
Mailing Address - Fax:225-421-1125
Practice Address - Street 1:4424 SUMRALL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-6051
Practice Address - Country:US
Practice Address - Phone:225-276-4408
Practice Address - Fax:225-421-1125
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA811490703Medicaid