Provider Demographics
NPI:1932107885
Name:BROWN, DEBRA A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
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 1:408 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1015
Mailing Address - Country:US
Mailing Address - Phone:585-786-0200
Mailing Address - Fax:585-786-2853
Practice Address - Street 1:34 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1017
Practice Address - Country:US
Practice Address - Phone:585-786-2290
Practice Address - Fax:585-786-2853
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300945-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01509493Medicaid
NYDD2099Medicare ID - Type Unspecified
NY01509493Medicaid