Provider Demographics
NPI:1609629922
Name:BROWN, KATRYN NATASHA
Entity Type:Individual
Prefix:
First Name:KATRYN
Middle Name:NATASHA
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 1:287 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1345
Mailing Address - Country:US
Mailing Address - Phone:978-766-3789
Mailing Address - Fax:
Practice Address - Street 1:55 BROOKSBY VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1444
Practice Address - Country:US
Practice Address - Phone:978-777-0721
Practice Address - Fax:978-777-6963
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADOP6610156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician