Healthcare Provider Details

I. General information

NPI: 1528656196
Provider Name (Legal Business Name): ERIN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13245 KESSLER RD
CAIRO IL
62914-3101
US

IV. Provider business mailing address

PO BOX 3008
CARBONDALE IL
62902-3008
US

V. Phone/Fax

Practice location:
  • Phone: 618-734-4400
  • Fax: 618-477-8557
Mailing address:
  • Phone: 618-457-0450
  • Fax: 618-457-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2091021649
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: