Provider Demographics
NPI:1124780929
Name:BROWN, ALEXANDRIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6665 STATE ROUTE 146 E
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-3122
Mailing Address - Country:US
Mailing Address - Phone:618-658-8331
Mailing Address - Fax:618-658-4027
Practice Address - Street 1:6665 STATE ROUTE 146 E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-3122
Practice Address - Country:US
Practice Address - Phone:618-658-8331
Practice Address - Fax:618-658-4027
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.003371363L00000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health