Provider Demographics
NPI:1396224705
Name:BROWN, VIRGINIA DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DAWN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 LAKESIDE DR APT B
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-3103
Mailing Address - Country:US
Mailing Address - Phone:812-583-9582
Mailing Address - Fax:
Practice Address - Street 1:638 LAKESIDE DR APT B
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-3103
Practice Address - Country:US
Practice Address - Phone:812-583-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27070318A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse