Healthcare Provider Details

I. General information

NPI: 1811482318
Provider Name (Legal Business Name): MARY ELIZABETH BROWN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 21ST AVE
ROCK VALLEY IA
51247-1420
US

IV. Provider business mailing address

1202 21ST AVE
ROCK VALLEY IA
51247-1420
US

V. Phone/Fax

Practice location:
  • Phone: 712-476-8000
  • Fax: 712-476-8064
Mailing address:
  • Phone: 712-476-8000
  • Fax: 712-476-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA151610
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: