Basic Information
| Provider Information | |||||||||
| NPI: | 1306117221 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RHONDA G. BROWN | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6434 SOMERSBY DR | ||||||||
| Address2: | |||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295768936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432512866 | ||||||||
| FaxNumber: | 8432365088 | ||||||||
| Practice Location | |||||||||
| Address1: | 6434 SOMERSBY DR | ||||||||
| Address2: | |||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295768936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432512866 | ||||||||
| FaxNumber: | 8432365088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | FNP | ||||||||
| AuthorizedOfficialTelephone: | 8432512866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | FNP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | APN-1744 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | NP0721 | 05 | SC | MEDICAID |