Provider Demographics
NPI:1679017867
Name:BROWN, NATHAN CUNNINGHAM
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CUNNINGHAM
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W MAGNOLIA ST
Mailing Address - Street 2:SUITE 423
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4368
Mailing Address - Country:US
Mailing Address - Phone:360-284-7020
Mailing Address - Fax:866-815-3945
Practice Address - Street 1:114 W MAGNOLIA ST
Practice Address - Street 2:SUITE 423
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4368
Practice Address - Country:US
Practice Address - Phone:360-284-7020
Practice Address - Fax:866-815-3945
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical