Provider Demographics
NPI:1346283728
Name:BROWN, PHYLLIS B (PA)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7191 N MILLBROOK AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3365
Mailing Address - Country:US
Mailing Address - Phone:559-261-0266
Mailing Address - Fax:559-261-1307
Practice Address - Street 1:7191 N MILLBROOK AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3365
Practice Address - Country:US
Practice Address - Phone:559-261-0266
Practice Address - Fax:559-261-1307
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S61813Medicare UPIN