Healthcare Provider Details

I. General information

NPI: 1023943941
Provider Name (Legal Business Name): ANDREA ALYSE BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4291 N RINDLE LN
BLOOMINGTON IN
47404-1234
US

IV. Provider business mailing address

4291 N RINDLE LN
BLOOMINGTON IN
47404-1234
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-0500
  • Fax:
Mailing address:
  • Phone: 909-557-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06260671
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: