Provider Demographics
NPI:1558735548
Name:BROWN, AMBER (LMP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4257 KELLUM RANCH RD NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-9627
Mailing Address - Country:US
Mailing Address - Phone:360-362-9620
Mailing Address - Fax:360-443-6250
Practice Address - Street 1:2080 SE SEDGWICK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-7003
Practice Address - Country:US
Practice Address - Phone:360-602-0475
Practice Address - Fax:360-443-6250
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60322798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist