Provider Demographics
NPI:1902649130
Name:BRAWNER, ANDREW SPENCER
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:SPENCER
Last Name:BRAWNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 APPLESEED DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1102
Mailing Address - Country:US
Mailing Address - Phone:856-904-0962
Mailing Address - Fax:
Practice Address - Street 1:18 E BUTTERFLY WAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3933
Practice Address - Country:US
Practice Address - Phone:856-904-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3856667171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach