Provider Demographics
NPI:1437348612
Name:BROWN, TERRI LENELLE (SA-C)
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:LENELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 IVY LN
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-1364
Mailing Address - Country:US
Mailing Address - Phone:804-862-2975
Mailing Address - Fax:
Practice Address - Street 1:59 IVY LN
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-1364
Practice Address - Country:US
Practice Address - Phone:804-862-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07-258363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical