Provider Demographics
NPI:1629291208
Name:BROWN, BLANCHE REBECCA (CPNP)
Entity Type:Individual
Prefix:MS
First Name:BLANCHE
Middle Name:REBECCA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 CANTER CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-6803
Mailing Address - Country:US
Mailing Address - Phone:410-519-7920
Mailing Address - Fax:
Practice Address - Street 1:901 TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4822
Practice Address - Country:US
Practice Address - Phone:410-612-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124397363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics