MEDICARE: MANDIE MICHELLE BROWN ARNP

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	363LF0000X	Family Nurse Practitioner	AP61152590	WA

General Provider Information

NPI Number	:	1942808506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDIE MICHELLE BROWN ARNP

Provider Business Mailing Address
First Line	:	7633 RUSHMORE WAY NE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98516-1340
Country	:	US
Telephone Number	:	360-304-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 3RD AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1010
Country	:	US
Telephone Number	:	360-754-3934
Fax Number	:

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

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	05/18/2026

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