Healthcare Provider Details

I. General information

NPI: 1619750957
Provider Name (Legal Business Name): MELISSA BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W CHAMBERS ST
MILWAUKEE WI
53210-1650
US

IV. Provider business mailing address

9853 N CEDARBURG RD
MEQUON WI
53092-4568
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2501
  • Fax:
Mailing address:
  • Phone: 608-469-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number176922-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: