Provider Demographics
NPI:1245318690
Name:BROWN, ALMIRA SUE
Entity type:Individual
Prefix:
First Name:ALMIRA
Middle Name:SUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W BELLA DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5250
Mailing Address - Country:US
Mailing Address - Phone:765-668-5989
Mailing Address - Fax:765-651-6642
Practice Address - Street 1:1411 W BELLA DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5250
Practice Address - Country:US
Practice Address - Phone:765-668-5989
Practice Address - Fax:765-651-6642
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000918363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING40389Medicare UPIN