Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01027735A | IN |
Y | 207VG0400X | Gynecologist | 01027735A | IN |
NPI | 1194764449 |
---|---|
Provider Name | Dr. Sandra R. Brown |
First Address | South Bend, IN 46617-1924 |
Second Address | Bremen, IN 46506-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100338010 | (05) | IN |
D95588 | (02) | IN |