Healthcare Provider Details

I. General information

NPI: 1013999028
Provider Name (Legal Business Name): SUSAN MARIE BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CIRCULAR AVE
HAMDEN CT
06514-4004
US

IV. Provider business mailing address

PO BOX 9805
NEW HAVEN CT
06536-0805
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-6253
  • Fax: 203-288-0948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number001395
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: