Provider Demographics
NPI:1134676133
Name:HOLLY JOHANTGEN BROWN, PA
Entity Type:Organization
Organization Name:HOLLY JOHANTGEN BROWN, PA
Other - Org Name:BRUNSWICK INTEGRATIVE HEALTH; HOLLY J. BROWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YARMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-809-2282
Mailing Address - Street 1:331 MAINE ST STE 11
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3359
Mailing Address - Country:US
Mailing Address - Phone:207-809-2282
Mailing Address - Fax:207-809-2146
Practice Address - Street 1:331 MAINE ST STE 11
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3359
Practice Address - Country:US
Practice Address - Phone:727-432-5849
Practice Address - Fax:207-809-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770995888OtherINDIVIDUAL NPI
1194882191OtherINDIVIDUAL NPI