Provider Demographics
NPI:1467689679
Name:BROWN, SUSAN GENEICE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GENEICE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1735
Mailing Address - Country:US
Mailing Address - Phone:970-323-8603
Mailing Address - Fax:
Practice Address - Street 1:2686 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8817
Practice Address - Country:US
Practice Address - Phone:970-298-6918
Practice Address - Fax:970-298-7520
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003991A363LF0000X
CO0991853-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily