Provider Demographics
NPI:1154437846
Name:BROWN, RENA IFEOMA (ANP-BC, GNP-BC,PMHNP)
Entity type:Individual
Prefix:MISS
First Name:RENA
Middle Name:IFEOMA
Last Name:BROWN
Suffix:
Gender:F
Credentials:ANP-BC, GNP-BC,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N MULDOON RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-6104
Mailing Address - Country:US
Mailing Address - Phone:907-257-4854
Mailing Address - Fax:
Practice Address - Street 1:1201 N MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6104
Practice Address - Country:US
Practice Address - Phone:907-257-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19101363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA918236779AMedicaid
Q74593Medicare UPIN
GA50BBKWXMedicare PIN