MEDICARE: EBONEE MARLENE BROWN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	279559-1	NY
2	163W00000X	Registered Nurse	794763-01	NY

General Provider Information

NPI Number	:	1538472063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONEE MARLENE BROWN RN

Provider Business Mailing Address
First Line	:	8 HARVEST HILL LN
Second Line	:	MIDDLETOWN
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2614
Country	:	US
Telephone Number	:	347-236-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 HARVEST HILL LANE
Second Line	:	PRIVATE HOUSE
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-0000
Country	:	US
Telephone Number	:	347-236-9382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	09/30/2021

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