Provider Demographics
NPI:1407845696
Name:BROWN, ALICE DILLON (NP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:DILLON
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:126 HAYES RD
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1835
Practice Address - Country:US
Practice Address - Phone:518-376-9324
Practice Address - Fax:518-376-9324
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02502463Medicaid
NYS28213Medicare UPIN
NYRA1426Medicare ID - Type Unspecified
DCP00858306OtherRAILROAD MEDICARE
DC154562YTFMedicare PIN