Provider Demographics
NPI:1164860706
Name:BROWN, RENEE MICHELLE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AS, RN,
Mailing Address - Street 1:2776 AMBERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-1433
Mailing Address - Country:US
Mailing Address - Phone:574-722-5151
Mailing Address - Fax:574-735-2563
Practice Address - Street 1:2776 AMBERWOOD PLACE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901
Practice Address - Country:US
Practice Address - Phone:574-722-5151
Practice Address - Fax:574-735-2563
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28206237A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse