Basic Information
| Provider Information | |||||||||
| NPI: | 1972556140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 MATING LUTHER KING JR. BLVD. | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278512656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199333301 | ||||||||
| FaxNumber: | 1919333375 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199333301 | ||||||||
| FaxNumber: | 9199333375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SW0102X | 486 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Women's Health | 367A00000X | 486 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 700091 | 05 | NC | MEDICAID |