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General NPI Number Information
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NPI Number | 1609139526
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Entity Type | Individual
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Provider Name | SUSAN B. BROWN NP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 84 MARGINAL WAY SUITE 700
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City | PORTLAND
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State | ME
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Zip | 04101
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Country | US
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Telephone | 207-774-5816
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Fax | 207-523-8597
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Provider Business Mailing Address
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Address Line | 100 GANNETT DRIVE SUITE C
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-523-3649
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Fax | 207-874-1483
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | CNP121033
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License Number State | ME
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