Provider Demographics
NPI:1245294305
Name:BROWN, NANCY S (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BRENNER AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2515
Mailing Address - Country:US
Mailing Address - Phone:704-638-9000
Mailing Address - Fax:
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-04-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-10-05
Provider Licenses
StateLicense IDTaxonomies
NY010098363A00000X
NC0010-03369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02716847Medicaid
NYPA1317Medicare PIN
NYQ56599Medicare UPIN
NYJ400022120Medicare PIN
NY02716847Medicaid