Provider Demographics
NPI:1629618418
Name:BROWN, ROXANN
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:
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 1:239 OGDEN STREET
Mailing Address - Street 2:1ST FL
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608
Mailing Address - Country:US
Mailing Address - Phone:973-510-6869
Mailing Address - Fax:
Practice Address - Street 1:3036A GUNTHER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3210
Practice Address - Country:US
Practice Address - Phone:973-510-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336382164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse