Provider Demographics
NPI:1851567820
Name:BROWNELL, MARILYNNE M
Entity Type:Individual
Prefix:
First Name:MARILYNNE
Middle Name:M
Last Name:BROWNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR STE 309
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7829
Mailing Address - Country:US
Mailing Address - Phone:949-640-0434
Mailing Address - Fax:949-640-0277
Practice Address - Street 1:360 SAN MIGUEL DR STE 309
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7829
Practice Address - Country:US
Practice Address - Phone:949-640-0434
Practice Address - Fax:949-640-0277
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282740363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner