Provider Demographics
NPI:1215266044
Name:BROWN, INGRID M (LISC PRACTICAL NURSE)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:LISC PRACTICAL NURSE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2141 CROTONA AVE
Mailing Address - Street 2:APT 7H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2705
Mailing Address - Country:US
Mailing Address - Phone:917-697-9230
Mailing Address - Fax:
Practice Address - Street 1:2141 CROTONA AVE
Practice Address - Street 2:APT 7H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2705
Practice Address - Country:US
Practice Address - Phone:917-697-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY253124-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse