Healthcare Provider Details

I. General information

NPI: 1942982145
Provider Name (Legal Business Name): COLLEEN MARIE BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

921 S LONG DR STE 205
ROCKINGHAM NC
28379-4874
US

IV. Provider business mailing address

921 S LONG DR STE 205
ROCKINGHAM NC
28379-4874
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-3477
  • Fax: 910-417-3489
Mailing address:
  • Phone: 910-417-3477
  • Fax: 910-417-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number217076
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: