Provider Demographics
NPI:1891815395
Name:BROWN, PAUL PEYTON (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:PEYTON
Last Name:BROWN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PENN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1637
Mailing Address - Country:US
Mailing Address - Phone:609-923-1866
Mailing Address - Fax:856-225-6186
Practice Address - Street 1:326 PENN ST
Practice Address - Street 2:RUTGERS UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1410
Practice Address - Country:US
Practice Address - Phone:856-225-6005
Practice Address - Fax:856-225-6005
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05032500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NN05032500OtherAPN STATE LICENSE
NJP00079000OtherCDS
NJ26NO05032500OtherRN LICENSE