Individual
MISS JOAN ICILDA BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3341 MEADOVISTA DR, ELLENWOOD, GA 30294-6638
(917) 843-8386
Mailing address
3341 MEADOVISTA DR, ELLENWOOD, GA 30294-6638
(917) 843-8386
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN177358
GA
363LP2300X
Primary Care Nurse Practitioner
Primary
RN177358
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F10181019
CERTIFICATION
GA
Enumeration date
12/17/2018
Last updated
12/17/2018
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