Provider Demographics
NPI:1639390487
Name:BROWN, STEPHANIE RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:17914 NANES DR.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1268
Mailing Address - Country:US
Mailing Address - Phone:832-766-2448
Mailing Address - Fax:281-580-4498
Practice Address - Street 1:17914 NANES DR.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1268
Practice Address - Country:US
Practice Address - Phone:832-766-2448
Practice Address - Fax:281-580-4498
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ29628Medicare UPIN