Healthcare Provider Details

I. General information

NPI: 1750090635
Provider Name (Legal Business Name): NICOLE RENEE BROWN RN-BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 ODLIN RD
BANGOR ME
04401-6709
US

IV. Provider business mailing address

75 W SIDE DR
VERONA ISLAND ME
04416-3106
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-7765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN76386
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: