Provider Demographics
NPI:1760117741
Name:BROWN, LEEANN (RN)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:
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 1:2033 MAIN ST.
Mailing Address - Street 2:LEVEL 2
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331
Mailing Address - Country:US
Mailing Address - Phone:978-249-9490
Mailing Address - Fax:978-249-9514
Practice Address - Street 1:2033 MAIN ST.
Practice Address - Street 2:LEVEL 2
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331
Practice Address - Country:US
Practice Address - Phone:978-249-9490
Practice Address - Fax:978-249-9514
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse