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General NPI Number Information
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NPI Number | 1760763262
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Entity Type | Individual
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Provider Name | MS. EVANGELINE BROWN
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Gender | Female
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 7 LINCOLN ST STE 200
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City | WAKEFIELD
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State | MA
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Zip | 01880-3033
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Country | US
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Telephone | 781-246-8811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1404
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City | WAKEFIELD
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State | MA
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Zip | 01880-5404
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Country | US
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Telephone | 781-246-8811
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 330236-00
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License Number State | MA
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