Healthcare Provider Details

I. General information

NPI: 1659059772
Provider Name (Legal Business Name): MS. CONSTANCE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

1502 RECTORY CT
FAYETTEVILLE NC
28314-1865
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax:
Mailing address:
  • Phone: 910-703-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberBROW-11018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: