Provider Demographics
NPI:1194788463
Name:BROWN, LOIS JEAN (NP)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866-0210
Mailing Address - Country:US
Mailing Address - Phone:757-859-6161
Mailing Address - Fax:757-859-6452
Practice Address - Street 1:8575 IVOR RD
Practice Address - Street 2:PO BOX 210
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866
Practice Address - Country:US
Practice Address - Phone:757-859-6161
Practice Address - Fax:757-859-6452
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024109487363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003971Medicaid
VAP00127832OtherRAILROAD MEDICARE
VA7783523Medicaid
VAP00127832OtherRAILROAD MEDICARE
VA7783523Medicaid