MEDICARE: DR. SUSAN A BROWN PHD, APNP

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	101YP2500X	Professional Counselor	613-125	WI
2	1041C0700X	Clinical Social Worker	3678-123	WI
3	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	52325-030	WI
4	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	796-033	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407990815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN A BROWN PHD, APNP

Provider Business Mailing Address
First Line	:	402 GAMMON PLACE
Second Line	:	STE 290
City	:	MADISON
State	:	WI
Zip	:	53719-1075
Country	:	US
Telephone Number	:	608-833-9770
Fax Number	:	608-833-1197

Provider Business Practice Location Address
First Line	:	402 GAMMON PL STE 290
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1075
Country	:	US
Telephone Number	:	608-833-9770
Fax Number	:	608-833-1197

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

Provider Enumeration Date	:	02/18/2007
Last Update Date	:	10/15/2011

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