Provider Demographics
NPI:1407565054
Name:BROWN, RANDE
Entity Type:Individual
Prefix:
First Name:RANDE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RANDE
Other - Middle Name:
Other - Last Name:ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2161 W FOUNTAIN CITY PIKE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47341-9793
Mailing Address - Country:US
Mailing Address - Phone:765-993-5754
Mailing Address - Fax:
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28238036A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse