Provider Demographics
NPI:1154426450
Name:BROWN, LORRAINE SUSAN (MSN,RN,CS,ANP)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:SUSAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSN,RN,CS,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 1ST CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2729
Mailing Address - Country:US
Mailing Address - Phone:636-946-4140
Mailing Address - Fax:636-946-1104
Practice Address - Street 1:723 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2729
Practice Address - Country:US
Practice Address - Phone:636-946-4140
Practice Address - Fax:636-946-1104
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S87380Medicare UPIN
MO000080485Medicare PIN