1679672059 NPI number — MS. JUDITH L BROWN RPH

Table of content: MS. JUDITH L BROWN RPH (NPI 1679672059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679672059 NPI number — MS. JUDITH L BROWN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JUDITH
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1679672059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-336-7506
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 ABALONE LOOP
Provider Second Line Business Practice Location Address:
MESCALEN INDIAN HOSPITAL
Provider Business Practice Location Address City Name:
MESCALEN
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88340-0210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-464-4441
Provider Business Practice Location Address Fax Number:
505-464-4422
Provider Enumeration Date:
09/21/2006

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: 183500000X , with the licence number:  4388 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 13960 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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