=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275611618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN A. BROWN F.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 03/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MEMORIAL DR
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62002-6722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-433-7066
-----------------------------------------------------
Fax | 618-433-7060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 670 MASON RIDGE CENTER DR SUITE 300
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-8573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-996-7644
-----------------------------------------------------
Fax | 314-996-7658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 041191369
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------