Provider Demographics
NPI:1275076440
Name:BROWN, BARBARA (NURSE)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 SPACHT RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9262
Mailing Address - Country:US
Mailing Address - Phone:937-456-2366
Mailing Address - Fax:
Practice Address - Street 1:3152 SPACHT RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9262
Practice Address - Country:US
Practice Address - Phone:937-456-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.114320-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse