Provider Demographics
NPI:1649380965
Name:DAVID M BROWN, CRNA PS
Entity type:Organization
Organization Name:DAVID M BROWN, CRNA PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:509-332-4051
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-0487
Mailing Address - Country:US
Mailing Address - Phone:509-332-4051
Mailing Address - Fax:509-332-4051
Practice Address - Street 1:1630 23RD AVE STE 901B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6353
Practice Address - Country:US
Practice Address - Phone:509-298-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTAX ID
ID=========OtherTAX ID