Provider Demographics
NPI:1922476548
Name:BROWN, PATRICE
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
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:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-0611
Mailing Address - Country:US
Mailing Address - Phone:631-764-8062
Mailing Address - Fax:
Practice Address - Street 1:1750 W MAIN ST
Practice Address - Street 2:S14
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3100
Practice Address - Country:US
Practice Address - Phone:631-764-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program