Healthcare Provider Details

I. General information

NPI: 1124506860
Provider Name (Legal Business Name): BRANDON BROWN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 PIERCE DR
COLUMBUS OH
43223-2425
US

IV. Provider business mailing address

61 KRAFT DR
ASHVILLE OH
43103-1421
US

V. Phone/Fax

Practice location:
  • Phone: 614-223-1650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.369118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: