Provider Demographics
NPI:1275640211
Name:BROWN, CONCHA D (CRNA)
Entity Type:Individual
Prefix:
First Name:CONCHA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CONCHA
Other - Middle Name:
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5702 229TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9871
Mailing Address - Country:US
Mailing Address - Phone:651-329-9869
Mailing Address - Fax:651-646-3124
Practice Address - Street 1:1544 SHELDON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2331
Practice Address - Country:US
Practice Address - Phone:651-646-3091
Practice Address - Fax:651-646-3124
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 053914-4163W00000X
MN016389367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered