Provider Demographics
NPI:1497142038
Name:BROWN, LOLITA
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:
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 1:938 CINNAMINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-1805
Mailing Address - Country:US
Mailing Address - Phone:609-233-7636
Mailing Address - Fax:
Practice Address - Street 1:938 CINNAMINSON AVE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NJ
Practice Address - Zip Code:08065-1805
Practice Address - Country:US
Practice Address - Phone:609-233-7636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00553000363LF0000X
PASP014567363LF0000X
NC272774363LF0000X
NC5008138363LF0000X
GARN310858163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily