Provider Demographics
NPI:1790384279
Name:BROWN, DANIELL LAVINAH (PMHNP)
Entity Type:Individual
Prefix:
First Name:DANIELL
Middle Name:LAVINAH
Last Name:BROWN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W CAMELBACK RD STE 715
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2529
Mailing Address - Country:US
Mailing Address - Phone:510-284-5113
Mailing Address - Fax:
Practice Address - Street 1:24 W CAMELBACK RD STE 715
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2529
Practice Address - Country:US
Practice Address - Phone:510-284-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282708363LP0808X
OR10001250363LP0808X
CA95016408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty