Provider Demographics
NPI:1770827503
Name:BROWN, MARTHA ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:KINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04947-4208
Mailing Address - Country:US
Mailing Address - Phone:207-265-4555
Mailing Address - Fax:207-264-5004
Practice Address - Street 1:25 DEPOT ST
Practice Address - Street 2:
Practice Address - City:KINGFIELD
Practice Address - State:ME
Practice Address - Zip Code:04947-4208
Practice Address - Country:US
Practice Address - Phone:207-265-4555
Practice Address - Fax:207-264-5004
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2022-07-08
Deactivation Date:2022-06-07
Deactivation Code:
Reactivation Date:2022-07-08
Provider Licenses
StateLicense IDTaxonomies
MECNP171018363LF0000X
FLARNP1514222363LF0000X
MI4704305289363LF0000X
AK1461363LF0000X
NMCNP-02420363LF0000X
AZAP8534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0093046000Medicaid
NM26304244Medicaid
FLY0J7WOtherFLORIDA BLUE
FL0093046000Medicaid