Healthcare Provider Details

I. General information

NPI: 1750662144
Provider Name (Legal Business Name): SUSAN MICHELE BROWN NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

IV. Provider business mailing address

5928 WILSON DR
HUNTINGTON WV
25705-2621
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2252
  • Fax:
Mailing address:
  • Phone: 304-633-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number59553
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: