=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396335485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA MARIE BROWN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2021
-----------------------------------------------------
Last Update Date | 01/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 PIKE ST
-----------------------------------------------------
City | HUNTINGDON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16654-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-643-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 69
-----------------------------------------------------
City | LANSE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16849-0069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-880-1752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | SP023113
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------