Healthcare Provider Details

I. General information

NPI: 1891912796
Provider Name (Legal Business Name): GLORIA BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WESTFIELD AVE
ELIZABETH NJ
07208-1325
US

IV. Provider business mailing address

970 HARDING RD
ELIZABETH NJ
07208-1048
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-8375
  • Fax: 908-352-8858
Mailing address:
  • Phone: 908-352-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number26NO05412200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: