Provider Demographics
NPI:1912081209
Name:BROWN, MARIE SCOTT (RN, PNP, NMNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:SCOTT
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN, PNP, NMNP
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 1001
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-8001
Mailing Address - Country:US
Mailing Address - Phone:503-366-4005
Mailing Address - Fax:503-366-0314
Practice Address - Street 1:1621 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6221
Practice Address - Country:US
Practice Address - Phone:503-366-4005
Practice Address - Fax:503-366-0314
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081045238N2363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117403Medicaid