1417187402 NPI number — DR. ROXANNE MARIE BROWN PHD

Table of content: DR. ROXANNE MARIE BROWN PHD (NPI 1417187402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417187402 NPI number — DR. ROXANNE MARIE BROWN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
ROXANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYSINGER / MOORE
Provider Other First Name:
ROXANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417187402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 NAPA VALLEJO HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94558-6293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-253-5000
Provider Business Mailing Address Fax Number:
916-654-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 NAPA VALLEJO HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-253-5000
Provider Business Practice Location Address Fax Number:
916-654-3186
Provider Enumeration Date:
07/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 21599 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 21599 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)