Healthcare Provider Details

I. General information

NPI: 1053004879
Provider Name (Legal Business Name): SYDNEY BROWN DNP-APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY MORRIS

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CALDWELL BLVD
NAMPA ID
83651-1707
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2892
  • Fax: 208-809-2893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53666
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: