Provider Demographics
NPI:1407990815
Name:BROWN, SUSAN A (PHD, APNP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 GAMMON PLACE
Mailing Address - Street 2:STE 290
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1075
Mailing Address - Country:US
Mailing Address - Phone:608-833-9770
Mailing Address - Fax:608-833-1197
Practice Address - Street 1:402 GAMMON PL STE 290
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1075
Practice Address - Country:US
Practice Address - Phone:608-833-9770
Practice Address - Fax:608-833-1197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI613-125101YP2500X
WI3678-1231041C0700X
WI52325-030163WP0809X
WI796-033364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39400900Medicaid
WI39400900Medicaid