Provider Demographics
NPI:1063699130
Name:BROWN, AIMEE (MSOM, LAC)
Entity type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N56W39325 WISCONSIN AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2192
Mailing Address - Country:US
Mailing Address - Phone:414-416-3278
Mailing Address - Fax:
Practice Address - Street 1:N56W39325 WISCONSIN AVE UNIT C
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2192
Practice Address - Country:US
Practice Address - Phone:414-416-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 342-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1063699130OtherI DONT KNOW