Provider Demographics
NPI:1962612143
Name:BROWN, MARYANN (RN)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:RICCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4000
Mailing Address - Country:US
Mailing Address - Phone:516-747-5644
Mailing Address - Fax:516-747-2556
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4000
Practice Address - Country:US
Practice Address - Phone:516-747-5644
Practice Address - Fax:516-747-2556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY310653OtherNY STATE LICENSE NUMBER