MEDICARE: MRS. MARVA BROWN RN

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	163W00000X	Registered Nurse	287353-1	NY
2	163WS0200X	School Registered Nurse	287353-1	NY

General Provider Information

NPI Number	:	1417215674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARVA BROWN RN

Provider Business Mailing Address
First Line	:	2839 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2151
Country	:	US
Telephone Number	:	718-724-8500
Fax Number	:	718-724-8515

Provider Business Practice Location Address
First Line	:	2839 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2151
Country	:	US
Telephone Number	:	718-724-8500
Fax Number	:	718-724-8515

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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