Provider Demographics
NPI:1790566156
Name:BROWN, GAYLEN TERRILL (RN)
Entity Type:Individual
Prefix:
First Name:GAYLEN
Middle Name:TERRILL
Last Name:BROWN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26536 TROUT AVENUE NORTH PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-0326
Mailing Address - Country:US
Mailing Address - Phone:715-431-0668
Mailing Address - Fax:
Practice Address - Street 1:26536 TROUT AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893
Practice Address - Country:US
Practice Address - Phone:715-431-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WID3HE7B163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty