1497183560 NPI number — ANGELA BROWN FNP

Table of content: ANGELA BROWN FNP (NPI 1497183560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497183560 NPI number — ANGELA BROWN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497183560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
792 E NEWCASTLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-0773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-380-5733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 FRESNO ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93706-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-478-5988
Provider Business Practice Location Address Fax Number:
559-478-5335
Provider Enumeration Date:
10/28/2013

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: 363LF0000X , with the licence number:  23743 , 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)

  • Identifier: GR0089960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ20843Z . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ02137Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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