Provider Demographics
NPI:1174067920
Name:BROWN, CORA L (NP)
Entity type:Individual
Prefix:MRS
First Name:CORA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 IMLAY CITY RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3258
Mailing Address - Country:US
Mailing Address - Phone:810-969-5617
Mailing Address - Fax:810-969-4095
Practice Address - Street 1:2081 IMLAY CITY RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3258
Practice Address - Country:US
Practice Address - Phone:810-969-5617
Practice Address - Fax:810-660-8485
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196899363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology