Healthcare Provider Details

I. General information

NPI: 1003401498
Provider Name (Legal Business Name): CARA R BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA R HANKS AND MAGEDANZ

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 36TH AVE
MOLINE IL
61265-7127
US

IV. Provider business mailing address

405 SW 2ND ST
ALEDO IL
61231-1707
US

V. Phone/Fax

Practice location:
  • Phone: 309-743-6700
  • Fax:
Mailing address:
  • Phone: 309-219-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022935
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: