Provider Demographics
NPI:1659884401
Name:BROWN, SAVANA MARISA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAVANA
Middle Name:MARISA
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAVANA
Other - Middle Name:MARISA
Other - Last Name:COCHRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4316
Mailing Address - Country:US
Mailing Address - Phone:541-930-8907
Mailing Address - Fax:541-245-4820
Practice Address - Street 1:520 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4316
Practice Address - Country:US
Practice Address - Phone:541-930-8907
Practice Address - Fax:541-245-4820
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA190601363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500758357Medicaid