1861072712 NPI number — BONNIE J BROWN

Table of content: BONNIE J BROWN (NPI 1861072712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861072712 NPI number — BONNIE J BROWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
BONNIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1861072712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 GRANT AVE.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-382-6871
Provider Business Mailing Address Fax Number:
703-682-6872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 GRANT AVE.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-382-6871
Provider Business Practice Location Address Fax Number:
703-682-6872
Provider Enumeration Date:
04/13/2021

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: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 171400000X . This is a "NATIONAL MEDICAL BOARD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com