Healthcare Provider Details

I. General information

NPI: 1417975954
Provider Name (Legal Business Name): CAROLYN RUTH BROWN OB GYN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 N WYATT DR
TUCSON AZ
85712
US

IV. Provider business mailing address

7217 E CRYSTAL MIST DR
TUCSON AZ
85750
US

V. Phone/Fax

Practice location:
  • Phone: 520-784-5808
  • Fax:
Mailing address:
  • Phone: 520-615-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN033331
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: