Provider Demographics
NPI:1386649309
Name:BROWN, ADRIENNE C (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 S WASATCH BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3539
Mailing Address - Country:US
Mailing Address - Phone:435-633-3626
Mailing Address - Fax:801-281-9923
Practice Address - Street 1:6440 S WASATCH BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:435-633-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7822984-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011070Medicaid