Provider Demographics
NPI:1396851028
Name:BROWN, ROXIE A (CNS)
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6926
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:368 E RIVERSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6896
Practice Address - Country:US
Practice Address - Phone:435-673-1149
Practice Address - Fax:435-673-1182
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT262909-4405364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT890000484OtherRAILROAD MEDICARE
UT$$$$$$$$$008Medicaid
UTS78885Medicare UPIN
UT$$$$$$$$$008Medicaid