Provider Demographics
NPI:1851475362
Name:BROWNLEE, RUSTY ALLEN
Entity Type:Individual
Prefix:MR
First Name:RUSTY
Middle Name:ALLEN
Last Name:BROWNLEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13430 N MERIDIAN ST
Mailing Address - Street 2:STE 364
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1405
Mailing Address - Country:US
Mailing Address - Phone:317-582-8403
Mailing Address - Fax:317-582-7316
Practice Address - Street 1:13430 N MERIDIAN ST
Practice Address - Street 2:STE 364
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1405
Practice Address - Country:US
Practice Address - Phone:317-582-8403
Practice Address - Fax:317-582-7316
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87595246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist