Provider Demographics
NPI:1528573847
Name:BROWN, SUSAN MARIE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:VT
Mailing Address - Zip Code:05820-0511
Mailing Address - Country:US
Mailing Address - Phone:802-754-6586
Mailing Address - Fax:
Practice Address - Street 1:610 CHAMBERLIN HILL ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:VT
Practice Address - Zip Code:05820
Practice Address - Country:US
Practice Address - Phone:802-754-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0017777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse