Individual
BERNICE BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1035
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1035
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
28201235A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28201235A
VA NORTHERN INDIANA HEALTH CARE SYSTEM
IN
05
—
28201235A
—
IN
Enumeration date
06/07/2022
Last updated
06/07/2022
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