Provider Demographics
NPI:1518067156
Name:BROWN, TERRI LEANN (CRNP OB/GYN)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LEANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNP OB/GYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2569
Mailing Address - Country:US
Mailing Address - Phone:301-759-5263
Mailing Address - Fax:301-777-2443
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:301-723-3940
Practice Address - Fax:301-723-3941
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122833363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD482501200Medicaid
MD21-1849OtherMEDICARE FQHC
PA1007288800005Medicaid