Provider Demographics
NPI:1447923248
Name:BROWN, TAMMY LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8415 KING STREET RD
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:NY
Practice Address - Zip Code:13140-9753
Practice Address - Country:US
Practice Address - Phone:425-309-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY176788OtherLICENSED PRACTICAL NURSE