Healthcare Provider Details

I. General information

NPI: 1760448120
Provider Name (Legal Business Name): VALERIE BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST SUITE 20-150
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

675 N SAINT CLAIR ST SUITE 20-150
CHICAGO IL
60611-5975
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8146
  • Fax: 312-695-7030
Mailing address:
  • Phone: 312-695-8146
  • Fax: 312-695-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085002587
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: