Provider Demographics
NPI:1326482415
Name:BROWN, KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
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 1:323 PIPE STAVE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1735
Mailing Address - Country:US
Mailing Address - Phone:631-543-6200
Mailing Address - Fax:631-543-6203
Practice Address - Street 1:155 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2212
Practice Address - Country:US
Practice Address - Phone:631-543-6200
Practice Address - Fax:631-543-6203
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223175-1OtherLICENSE