Provider Demographics
NPI:1518137637
Name:BROWN, DEBORAH J (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 PLOMONDON ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-5645
Mailing Address - Country:US
Mailing Address - Phone:360-313-1390
Mailing Address - Fax:360-313-1391
Practice Address - Street 1:4100 PLOMONDON ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-5645
Practice Address - Country:US
Practice Address - Phone:360-313-1390
Practice Address - Fax:360-313-1391
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AM0700X
WAPA60010583363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1080132OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
WAPA60010583OtherWASHINGTON STATE PHYSICIAN ASSISTANT LICENSE