Provider Demographics
NPI:1265988653
Name:BROWN, REMONA LYSA (NP)
Entity type:Individual
Prefix:DR
First Name:REMONA
Middle Name:LYSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:LYSA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:930 E MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3280
Mailing Address - Country:US
Mailing Address - Phone:517-253-7764
Mailing Address - Fax:517-372-1250
Practice Address - Street 1:930 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3280
Practice Address - Country:US
Practice Address - Phone:517-253-7764
Practice Address - Fax:517-372-1250
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA135501363LF0000X
MI4704284531363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily