Provider Demographics
NPI:1437842234
Name:BROWN, NICOLE DANAE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S 1ST ST APT 506
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5006
Mailing Address - Country:US
Mailing Address - Phone:701-350-8485
Mailing Address - Fax:
Practice Address - Street 1:215 S 1ST ST APT 506
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5006
Practice Address - Country:US
Practice Address - Phone:701-350-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant