Provider Demographics
NPI:1609448257
Name:BROWN, NOHORA AYDEE AGUDELO (NP)
Entity Type:Individual
Prefix:
First Name:NOHORA AYDEE
Middle Name:AGUDELO
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 CHERRY AVE STE R1049
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0766
Mailing Address - Country:US
Mailing Address - Phone:661-716-4703
Mailing Address - Fax:
Practice Address - Street 1:2901 SILLECT AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6372
Practice Address - Country:US
Practice Address - Phone:190-978-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016082363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care