Provider Demographics
NPI:1891466405
Name:BROWN, NICOLE SHANIQUE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SHANIQUE
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 1:2121 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-2015
Mailing Address - Country:US
Mailing Address - Phone:215-512-3423
Mailing Address - Fax:
Practice Address - Street 1:2121 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-2015
Practice Address - Country:US
Practice Address - Phone:215-512-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care