Provider Demographics
NPI:1114645884
Name:BROWN, NAOMI (MSN, RN, NCSN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSN, RN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25704
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-0704
Mailing Address - Country:US
Mailing Address - Phone:505-855-9791
Mailing Address - Fax:505-830-1771
Practice Address - Street 1:807 MOUNTAIN RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2441
Practice Address - Country:US
Practice Address - Phone:505-247-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM406125163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool