MEDICARE: ANNE BROWN PMHNP

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	200942680RN	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	201150100NP	OR

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
2	474259	OTHER	OR	REGENCE

General Provider Information

NPI Number	:	1710266226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE BROWN PMHNP

Provider Business Mailing Address
First Line	:	2165 SW MAIN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1123
Country	:	US
Telephone Number	:	503-915-1334
Fax Number	:	503-296-2643

Provider Business Practice Location Address
First Line	:	2165 SW MAIN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1123
Country	:	US
Telephone Number	:	503-915-1334
Fax Number	:	503-296-2643

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	03/29/2018

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