Provider Demographics
NPI:1629081138
Name:BROWN-SIENKO, TERISA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:TERISA
Middle Name:MARIE
Last Name:BROWN-SIENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S ANAHEIM HILLS RD
Mailing Address - Street 2:#206
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-282-6934
Mailing Address - Fax:714-282-6935
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:STE #206
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-6934
Practice Address - Fax:714-282-6935
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB24982Medicare PIN