Provider Demographics
NPI:1790915288
Name:BROWN, DAVID (BSN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 RICHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JACOB
Mailing Address - State:IL
Mailing Address - Zip Code:62281-1070
Mailing Address - Country:US
Mailing Address - Phone:618-667-1713
Mailing Address - Fax:
Practice Address - Street 1:402 SCOTT DR
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5325
Practice Address - Country:US
Practice Address - Phone:618-229-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024389163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse