Provider Demographics
NPI:1851453633
Name:BROWN, CHARLENE
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 70TH AVE
Mailing Address - Street 2:B-1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-1661
Mailing Address - Country:US
Mailing Address - Phone:215-924-9852
Mailing Address - Fax:215-683-1815
Practice Address - Street 1:1720 SOUTH BROAD STREET
Practice Address - Street 2:CITY OF PHILADELPHIA HEALTH DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:215-685-1811
Practice Address - Fax:215-683-1815
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP 001665 G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP 001665 GOtherLICENSE NUMBER