Provider Demographics
NPI:1689322851
Name:BROWN, MICHELLE CHRISTINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:CARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 RETREAT AVE STE 811
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2528
Mailing Address - Country:US
Mailing Address - Phone:860-522-5712
Mailing Address - Fax:
Practice Address - Street 1:100 RETREAT AVE STE 811
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-522-5712
Practice Address - Fax:860-520-4270
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10522363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily