Provider Demographics
NPI:1740513597
Name:BROWN, LIZA A (RN)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BISHOP ST
Mailing Address - Street 2:FRAMINGHAM
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8337
Mailing Address - Country:US
Mailing Address - Phone:774-641-0392
Mailing Address - Fax:
Practice Address - Street 1:4 BISHOP STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8301
Practice Address - Country:US
Practice Address - Phone:774-641-0392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1320858OtherMEDICAID GROUP #