Provider Demographics
NPI:1558347666
Name:BROWN, NANCY S (FNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 289
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-9700
Mailing Address - Country:US
Mailing Address - Phone:573-364-4914
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY ROAD 3610
Practice Address - Street 2:
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-9989
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-3861
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO096938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO096938OtherLICENSE