Provider Demographics
NPI:1932418423
Name:MARKLEY BROWN, MARY CRISTINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CRISTINE
Last Name:MARKLEY BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:CRISTINE
Other - Last Name:AMMEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2914 CROSSWAY RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7734
Mailing Address - Country:US
Mailing Address - Phone:262-290-8887
Mailing Address - Fax:
Practice Address - Street 1:2914 CROSSWAY RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-7734
Practice Address - Country:US
Practice Address - Phone:262-290-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14462-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse