Provider Demographics
NPI:1790882652
Name:BROWN, LAURIE L (MPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:FORT HARRISON
Mailing Address - State:MT
Mailing Address - Zip Code:59636-9703
Mailing Address - Country:US
Mailing Address - Phone:406-447-7505
Mailing Address - Fax:406-447-7235
Practice Address - Street 1:3687 VETERANS DR
Practice Address - Street 2:
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636-9703
Practice Address - Country:US
Practice Address - Phone:406-447-7505
Practice Address - Fax:406-447-7235
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000097493OtherBCBS
MT000097493OtherBCBS