Provider Demographics
NPI:1861446114
Name:BROWN, SUSAN C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MCINDOE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5022
Mailing Address - Country:US
Mailing Address - Phone:414-530-0221
Mailing Address - Fax:
Practice Address - Street 1:3901 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3948
Practice Address - Country:US
Practice Address - Phone:715-907-0900
Practice Address - Fax:715-803-6977
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1337363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41924400Medicaid
WI1861446114Medicaid
006000261XOtherHUMANA
WI1861446114Medicaid
WI68-086 0388Medicare PIN