Provider Demographics
NPI:1063636728
Name:BROWN, DIANE LYNN (ANP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-3105
Mailing Address - Country:US
Mailing Address - Phone:910-582-5403
Mailing Address - Fax:910-205-8435
Practice Address - Street 1:1000 W HAMLET AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4522
Practice Address - Country:US
Practice Address - Phone:910-205-0400
Practice Address - Fax:910-205-0090
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900264363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP30535Medicare UPIN