Healthcare Provider Details

I. General information

NPI: 1578079851
Provider Name (Legal Business Name): MEGAN RENEE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date: 03/05/2018
Reactivation Date: 03/15/2018

III. Provider practice location address

3465 S OLDCOUNTY RD
GREENBANK WA
98253-9825
US

IV. Provider business mailing address

3465 OLD COUNTY RD
GREENBANK WA
98253-9739
US

V. Phone/Fax

Practice location:
  • Phone: 360-672-2084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: