Healthcare Provider Details

I. General information

NPI: 1427012301
Provider Name (Legal Business Name): CAROL A BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 VEST MILL RD SUITE 100
WINSTON SALEM NC
27103-1323
US

IV. Provider business mailing address

3880 VEST MILL RD SUITE 100
WINSTON SALEM NC
27103-1323
US

V. Phone/Fax

Practice location:
  • Phone: 336-251-1114
  • Fax: 336-251-1116
Mailing address:
  • Phone: 336-251-1114
  • Fax: 336-251-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 156187
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: