Healthcare Provider Details

I. General information

NPI: 1629291208
Provider Name (Legal Business Name): BLANCHE REBECCA BROWN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 TRIMBLE RD
JOPPA MD
21085-4822
US

IV. Provider business mailing address

7920 CANTER CT
SEVERN MD
21144-6803
US

V. Phone/Fax

Practice location:
  • Phone: 410-612-1734
  • Fax:
Mailing address:
  • Phone: 410-519-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR124397
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: