Provider Demographics
NPI:1831643451
Name:BROWNSON, NIKALET MONIQUE
Entity Type:Individual
Prefix:
First Name:NIKALET
Middle Name:MONIQUE
Last Name:BROWNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKOLETTE
Other - Middle Name:MONIQUE
Other - Last Name:BROWNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1444 DE HARO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3241
Mailing Address - Country:US
Mailing Address - Phone:415-527-7252
Mailing Address - Fax:
Practice Address - Street 1:1444 DE HARO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3241
Practice Address - Country:US
Practice Address - Phone:415-527-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2523276172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07054ZMedicare PIN