Provider Demographics
NPI:1437672730
Name:BROWN, CORY ANN (RN)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2833
Mailing Address - Country:US
Mailing Address - Phone:440-796-0155
Mailing Address - Fax:
Practice Address - Street 1:1327 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2833
Practice Address - Country:US
Practice Address - Phone:440-796-0155
Practice Address - Fax:440-796-0155
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.118923.MEDS164W00000X
OHRN.518735163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse