1154656890 NPI number — MRS. COLLEEN MARIE BROWN PA-C

Table of content: MRS. COLLEEN MARIE BROWN PA-C (NPI 1154656890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154656890 NPI number — MRS. COLLEEN MARIE BROWN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
COLLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154656890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44871-0378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-626-6161
Provider Business Mailing Address Fax Number:
419-502-3511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29257 CENTER RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-899-7677
Provider Business Practice Location Address Fax Number:
440-899-7667
Provider Enumeration Date:
10/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA20594 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 004399 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)