Provider Demographics
NPI:1508133927
Name:BROWN, PHYLLIS ELANA (CRNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ELANA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RESERVOIR CIRCLE
Mailing Address - Street 2:STE. #201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-602-3322
Mailing Address - Fax:410-602-8363
Practice Address - Street 1:1 RESERVOIR CIRCLE
Practice Address - Street 2:STE. #201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-602-3322
Practice Address - Fax:410-602-8363
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDANCC-0021755207QB0002X
MDR068465363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine