Healthcare Provider Details

I. General information

NPI: 1407048523
Provider Name (Legal Business Name): SANDRA M BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA M NEMBHARD

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 10/12/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

3108 MOUNTAIN HILL DR
WAKE FOREST NC
27587-5005
US

V. Phone/Fax

Practice location:
  • Phone: 410-375-7652
  • Fax:
Mailing address:
  • Phone: 646-872-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number440644
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334908-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: