Provider Demographics
NPI:1669786125
Name:BROWN, LUKE ANTHONY (CRNP)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:ANTHONY
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:M/S 790
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:217-709-2386
Mailing Address - Fax:217-709-2344
Practice Address - Street 1:969 GREENTREE RD
Practice Address - Street 2:STE 310
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3328
Practice Address - Country:US
Practice Address - Phone:412-325-6593
Practice Address - Fax:412-325-6549
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP010822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025865140001Medicaid
195670YC1JMedicare PIN