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General NPI Number Information
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NPI Number | 1710587415
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Entity Type | Individual
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Provider Name | MARA S BROWN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 1215 E MICHIGAN AVE FL 6
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City | LANSING
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State | MI
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Zip | 48912-1811
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Country | US
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Telephone | 517-582-4385
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Fax | 517-364-2713
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Provider Business Mailing Address
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Address Line | 1215 E MICHIGAN AVE FL 6
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City | LANSING
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State | MI
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Zip | 48912-1811
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Country | US
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Telephone | 616-840-8000
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704222901
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License Number State | MI
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