Provider Demographics
NPI:1255791794
Name:BROWN, CARMEN MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
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 194
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:13121-0194
Mailing Address - Country:US
Mailing Address - Phone:315-708-6671
Mailing Address - Fax:
Practice Address - Street 1:3670 COUNTY ROUTE 6
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6275
Practice Address - Country:US
Practice Address - Phone:315-708-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317918164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse