Provider Demographics
NPI:1477824910
Name:BROWN, DEANNE M
Entity Type:Individual
Prefix:MISS
First Name:DEANNE
Middle Name:M
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 1:11705 MINARD RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14536-9602
Mailing Address - Country:US
Mailing Address - Phone:585-703-3300
Mailing Address - Fax:
Practice Address - Street 1:11705 MINARD RD
Practice Address - Street 2:
Practice Address - City:PORTAGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14536-9602
Practice Address - Country:US
Practice Address - Phone:585-703-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210216-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse