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General NPI Number Information
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NPI Number | 1548995897
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Entity Type | Individual
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Provider Name | DEENA M BROWN FNP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 2 SAINT ANTHONYS WAY STE 205
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City | ALTON
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State | IL
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Zip | 62002-4569
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Country | US
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Telephone | 618-462-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 SAINT LOUIS ST
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-1309
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Country | US
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Telephone | 618-660-9807
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209024436
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License Number State | IL
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