Healthcare Provider Details

I. General information

NPI: 1972913804
Provider Name (Legal Business Name): TONI BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W WESTERN AVE
SOUTH BEND IN
46601-2215
US

IV. Provider business mailing address

1573 MAPLE AVE
NOBLESVILLE IN
46060-2961
US

V. Phone/Fax

Practice location:
  • Phone: 574-299-4847
  • Fax:
Mailing address:
  • Phone: 317-473-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28178806A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: