Provider Demographics
NPI:1619674785
Name:BROWN, ANGELA LOUISIA ELSNER (MT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISIA ELSNER
Last Name:BROWN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56212-0384
Mailing Address - Country:US
Mailing Address - Phone:507-430-1550
Mailing Address - Fax:
Practice Address - Street 1:601 1ST ST W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MN
Practice Address - Zip Code:56256-1319
Practice Address - Country:US
Practice Address - Phone:507-430-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist