Healthcare Provider Details

I. General information

NPI: 1487818969
Provider Name (Legal Business Name): DINA MENARD BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DINA BROWN NP

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1602
US

IV. Provider business mailing address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1602
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7614
  • Fax:
Mailing address:
  • Phone: 757-314-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024167172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: