Provider Demographics
NPI:1366442386
Name:BROWN, CAROL L (RNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:BROWN-LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNP
Mailing Address - Street 1:3123 AMIGOS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504
Mailing Address - Country:US
Mailing Address - Phone:818-424-3780
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:POPULATION CARE SOUTH 1
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-424-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA257248OtherRNP LICENSE