Provider Demographics
NPI:1295041119
Name:BROWN, GWENDOLYN (RN)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRONXVILLE GLEN DR
Mailing Address - Street 2:#3-18
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6835
Mailing Address - Country:US
Mailing Address - Phone:646-796-6671
Mailing Address - Fax:
Practice Address - Street 1:16 BRONXVILLE GLEN DR
Practice Address - Street 2:#3-18
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6835
Practice Address - Country:US
Practice Address - Phone:646-796-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482293-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse