Provider Demographics
NPI:1538472063
Name:BROWN, EBONEE MARLENE (RN)
Entity Type:Individual
Prefix:
First Name:EBONEE
Middle Name:MARLENE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARVEST HILL LN
Mailing Address - Street 2:MIDDLETOWN
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2614
Mailing Address - Country:US
Mailing Address - Phone:347-236-9382
Mailing Address - Fax:
Practice Address - Street 1:8 HARVEST HILL LANE
Practice Address - Street 2:PRIVATE HOUSE
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-0000
Practice Address - Country:US
Practice Address - Phone:347-236-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279559-1164W00000X
NY794763-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse