Healthcare Provider Details

I. General information

NPI: 1376420208
Provider Name (Legal Business Name): MS. ANGELA MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 PARK EAST BLVD
LAFAYETTE IN
47905-0792
US

IV. Provider business mailing address

851 LIVERPOOL CT
LAFAYETTE IN
47909-2978
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-1772
  • Fax: 317-988-5631
Mailing address:
  • Phone: 217-259-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041.384501
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: