Healthcare Provider Details

I. General information

NPI: 1417406943
Provider Name (Legal Business Name): CASSANDRA F BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 WEDGEWOOD CT
EDEN NC
27288-2841
US

IV. Provider business mailing address

425 WEDGEWOOD CT
EDEN NC
27288-2841
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-3146
  • Fax: 336-641-5777
Mailing address:
  • Phone: 336-641-3146
  • Fax: 336-641-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: