Provider Demographics
NPI:1770830432
Name:BROWN, ATHENA (FNP)
Entity type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
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 36363
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07188-6306
Mailing Address - Country:US
Mailing Address - Phone:845-651-1400
Mailing Address - Fax:845-294-3758
Practice Address - Street 1:21 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1026
Practice Address - Country:US
Practice Address - Phone:845-986-3311
Practice Address - Fax:845-987-2484
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337535-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily