Provider Demographics
NPI:1750161667
Name:BROWN, MICHELLE RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3343
Mailing Address - Country:US
Mailing Address - Phone:307-682-4664
Mailing Address - Fax:
Practice Address - Street 1:1307 W 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3343
Practice Address - Country:US
Practice Address - Phone:307-682-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY36160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily