Provider Demographics
NPI:1992348379
Name:BROWN, OLIVIA JACKLYNNE (DNP, CNP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JACKLYNNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DNP, CNP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:JACKLYNNE
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 N PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-1243
Mailing Address - Country:US
Mailing Address - Phone:605-997-2471
Mailing Address - Fax:
Practice Address - Street 1:212 N PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1243
Practice Address - Country:US
Practice Address - Phone:605-997-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily