Provider Demographics
NPI:1659632941
Name:BROWN, KIMBERLY RENEE (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 42ND AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2532
Mailing Address - Country:US
Mailing Address - Phone:718-812-5116
Mailing Address - Fax:
Practice Address - Street 1:675 3RD AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5704
Practice Address - Country:US
Practice Address - Phone:212-204-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6240691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10307OtherTHE EXECU SEARCH GROUP