Provider Demographics
NPI:1972556140
Name:BROWN, MARY PATRICIA (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MATING LUTHER KING JR. BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27851-2656
Mailing Address - Country:US
Mailing Address - Phone:919-933-3301
Mailing Address - Fax:191-933-3375
Practice Address - Street 1:930 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2656
Practice Address - Country:US
Practice Address - Phone:919-933-3301
Practice Address - Fax:919-933-3375
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC486364SW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC700091Medicaid