Healthcare Provider Details

I. General information

NPI: 1891815395
Provider Name (Legal Business Name): PAUL PEYTON BROWN NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 PENN ST RUTGERS UNIVERSITY STUDENT HEALTH SERVICES
CAMDEN NJ
08102-1410
US

IV. Provider business mailing address

209 PENN ST
CAMDEN NJ
08102-1637
US

V. Phone/Fax

Practice location:
  • Phone: 856-225-6005
  • Fax: 856-225-6005
Mailing address:
  • Phone: 609-923-1866
  • Fax: 856-225-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN05032500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: