Basic Information
Provider Information
NPI: 1417984824
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: MARGARET
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 105 W STONE DR
Address2: SUITE 6A
City: KINGSPORT
State: TN
PostalCode: 376603365
CountryCode: US
TelephoneNumber: 4234087220
FaxNumber: 4234087405
Practice Location
Address1: 1 MEDICAL PARK BLVD
Address2:  
City: BRISTOL
State: TN
PostalCode: 376207430
CountryCode: US
TelephoneNumber: 4238441121
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/28/2006
LastUpdateDate: 05/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X46360TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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