Provider Demographics
NPI:1447628128
Name:BROWNELL, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BROWNELL
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 1:1550 HODGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161
Mailing Address - Country:US
Mailing Address - Phone:734-770-0740
Mailing Address - Fax:
Practice Address - Street 1:1900 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3114
Practice Address - Country:US
Practice Address - Phone:941-330-8885
Practice Address - Fax:941-906-8774
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021535367A00000X
MI4704199731176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife