Provider Demographics
NPI:1962681809
Name:TERRI BROWN SA-C
Entity Type:Organization
Organization Name:TERRI BROWN SA-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SA-C
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LENELLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-862-2975
Mailing Address - Street 1:59 IVY LN
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-1364
Mailing Address - Country:US
Mailing Address - Phone:804-862-2975
Mailing Address - Fax:
Practice Address - Street 1:59 IVY LN
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-1364
Practice Address - Country:US
Practice Address - Phone:804-862-2975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07-258363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty