Provider Demographics
NPI:1558436469
Name:BROWN-RUSSELL, ENID (NP)
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:
Last Name:BROWN-RUSSELL
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:EVERCARE
Mailing Address - Street 2:1 PENN PLAZA, STE. 725
Mailing Address - City:NEW YORK
Mailing Address - State:NC
Mailing Address - Zip Code:10119
Mailing Address - Country:US
Mailing Address - Phone:212-216-6606
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:EVERCARE
Practice Address - Street 2:1 PENN PLAZA, STE. 725
Practice Address - City:NEW YORK
Practice Address - State:NC
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:212-216-6606
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340297-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology