Provider Demographics
NPI:1548249402
Name:BROWN, RENEE L (NP)
Entity type:Individual
Prefix:
First Name:RENEE
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:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-0752
Mailing Address - Country:US
Mailing Address - Phone:336-835-3319
Mailing Address - Fax:
Practice Address - Street 1:3211 SHANNON RD
Practice Address - Street 2:SUITE300
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6322
Practice Address - Country:US
Practice Address - Phone:800-291-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201595363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB0860204OtherFEDERAL DEA