Provider Demographics
NPI:1255983581
Name:BROWN, MICHELLE RENA (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENA
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:125 MAPLE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7920
Mailing Address - Country:US
Mailing Address - Phone:814-693-2273
Mailing Address - Fax:
Practice Address - Street 1:125 MAPLE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-7920
Practice Address - Country:US
Practice Address - Phone:814-693-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN342190L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse