1487476875 NPI number — AUTUMN W BROWN MA,PHLEBOTOMIST

Table of content: AUTUMN W BROWN MA,PHLEBOTOMIST (NPI 1487476875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487476875 NPI number — AUTUMN W BROWN MA,PHLEBOTOMIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
AUTUMN
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,PHLEBOTOMIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCLOUD-BROWN
Provider Other First Name:
AUTUMN
Provider Other Middle Name:
WENDY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA,PHLEBOTOMIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487476875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6969 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE B150
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-336-1371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8917 W LAWRENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-336-1371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2024

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: 246RP1900X , with the licence number:  H7Z3Y8Z4 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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