Healthcare Provider Details

I. General information

NPI: 1124906060
Provider Name (Legal Business Name): EASTON MICHAEL BROWN RN-BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 HOWARD AVE
ALTOONA PA
16601-4804
US

IV. Provider business mailing address

419 1ST AVE
DUNCANSVILLE PA
16635-9469
US

V. Phone/Fax

Practice location:
  • Phone: 814-889-2011
  • Fax:
Mailing address:
  • Phone: 814-505-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN790849
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: