Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201150168NP | OR |
NPI | 1003082983 |
---|---|
Provider Name | Elaine Michele Brown |
First Address | Bend, OR 97701-6213 |
Second Address | Bend, OR 97701-6213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 10/02/2012 |