Provider Demographics
NPI:1962552273
Name:BROWN, LISA A (PAC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1568
Mailing Address - Country:US
Mailing Address - Phone:989-883-3800
Mailing Address - Fax:989-883-9131
Practice Address - Street 1:4497 SHEFFIELD PL
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2554
Practice Address - Country:US
Practice Address - Phone:989-883-3800
Practice Address - Fax:989-883-9131
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1381008Medicare UPIN