Provider Demographics
NPI:1487137600
Name:BROWN, ASHLEY MARIE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 ROUTE 20 WEST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084
Mailing Address - Country:US
Mailing Address - Phone:315-677-5501
Mailing Address - Fax:315-677-3154
Practice Address - Street 1:5957 ROUTE 20 WEST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084
Practice Address - Country:US
Practice Address - Phone:315-677-5501
Practice Address - Fax:315-677-3154
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1255469052Medicaid