Healthcare Provider Details

I. General information

NPI: 1861253544
Provider Name (Legal Business Name): ANN BROWN RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 N 16TH ST # B716
LAFAYETTE IN
47904-2119
US

IV. Provider business mailing address

1501 HARTFORD ST
LAFAYETTE IN
47904-2134
US

V. Phone/Fax

Practice location:
  • Phone: 765-428-5850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28152845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: