Provider Demographics
NPI:1689156465
Name:BROWN, ERICA RENEE (CNA)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7357
Mailing Address - Country:US
Mailing Address - Phone:631-326-7436
Mailing Address - Fax:
Practice Address - Street 1:35 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7357
Practice Address - Country:US
Practice Address - Phone:631-326-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY000410442E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide