Provider Demographics
NPI:1568573145
Name:BROWN, ALVIN GENE (NP)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:GENE
Last Name:BROWN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:330 NORTH WABASH AVENUE
Mailing Address - Street 2:SUITE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7616
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:441 N WABASH AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2612
Practice Address - Country:US
Practice Address - Phone:765-660-6000
Practice Address - Fax:765-651-7313
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001331A207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200040980AMedicaid
IN000000679334OtherANTHEM
IN200040980AMedicaid
INP10429Medicare UPIN