MARY ELLEN BROWN FNP NPI 1073794814

NPI Information

  • NPI: 1073794814
  • Provider Name: MARY ELLEN BROWN, FNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2600 SOUTHPARK AVENUE
    LACKAWANNA, NY
    ZIP 14218
  • Phone: (716) 822-2028

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NPI Details

Mary Ellen Brown, FNP is a family nurse practitioner in Lackawanna, NY. Mary Ellen Brown, FNP NPI is 1073794814. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2600 SOUTHPARK AVENUE
LACKAWANNA, NY
ZIP 14218-504
Phone: (716) 822-2028
Fax: (716) 822-2029

The NPI 1073794814 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/20/2007 and was last updated on 4/6/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyF335096-1NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19514408OTHERNEW YORKINDEPENDENT HEALTH
200028208101OTHERNEW YORKUNIVERA
3A400147939MEDICARE PINNEW YORK
4000529830001OTHERNEW YORKBLUE CROSS
501075516MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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