1073582664 NPI number — CHEYENNE K. BROWN CNM MLP-NURSE PRACTI

Table of content: CHEYENNE K. BROWN CNM MLP-NURSE PRACTI (NPI 1073582664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073582664 NPI number — CHEYENNE K. BROWN CNM MLP-NURSE PRACTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CHEYENNE
Provider Middle Name:
K.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM MLP-NURSE PRACTI
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:
1073582664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 READING ROAD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45202-1488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-721-3200
Provider Business Mailing Address Fax Number:
513-639-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3747 WEST FORK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45247-7548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-481-4777
Provider Business Practice Location Address Fax Number:
513-389-0473
Provider Enumeration Date:
03/16/2006

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: 367A00000X , with the licence number:  NM08212 , 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)

  • Identifier: 2571631 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200800130C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".