=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083695787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA G BROWER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2005
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1141 N ROAD ST SUITE G
-----------------------------------------------------
City | ELIZABETH CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-335-5424
-----------------------------------------------------
Fax | 252-335-1077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 N ROAD ST SUITE G
-----------------------------------------------------
City | ELIZABETH CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-335-5424
-----------------------------------------------------
Fax | 252-335-1077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 103887
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------