Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00900300 | NJ |
NPI | 1063977114 |
---|---|
Provider Name | Mrs. Althea Doreen Brown |
First Address | Teaneck, NJ 07666-6418 |
Second Address | Paramus, NJ 07652-4142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2019 |
Last Update Date | 03/02/2019 |