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General NPI Number Information
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NPI Number | 1104461599
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Entity Type | Individual
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Provider Name | SUSAN KAY BROWN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 121 E GRAND AVE STE 204
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City | LARAMIE
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State | WY
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Zip | 82070-3600
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Country | US
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Telephone | 307-316-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 121 E GRAND AVE STE 204
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City | LARAMIE
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State | WY
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Zip | 82070-3600
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Country | US
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Telephone | 307-316-4410
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Fax | 307-459-6972
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 44909
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License Number State | WY
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