Provider Demographics
NPI:1154206738
Name:BROWN, ELLISSA NICOLE
Entity type:Individual
Prefix:
First Name:ELLISSA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 KNOB ST APT 5
Mailing Address - Street 2:
Mailing Address - City:RICH CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24147-9700
Mailing Address - Country:US
Mailing Address - Phone:267-722-0365
Mailing Address - Fax:
Practice Address - Street 1:311 KNOB ST APT 5
Practice Address - Street 2:
Practice Address - City:RICH CREEK
Practice Address - State:VA
Practice Address - Zip Code:24147-9700
Practice Address - Country:US
Practice Address - Phone:267-722-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant