MEDICARE: DR. DEIDRA G BROWN GNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	340408	NY

General Provider Information

NPI Number	:	1255880993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEIDRA G BROWN GNP-BC

Provider Business Mailing Address
First Line	:	51 LINCOLN AVE E
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-2621
Country	:	US
Telephone Number	:	914-667-0279
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 LINCOLN AVE E
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-2621
Country	:	US
Telephone Number	:	914-667-0279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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