Provider Demographics
NPI:1912375783
Name:BROWN, FIONNUALA S (NP)
Entity Type:Individual
Prefix:
First Name:FIONNUALA
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5400
Mailing Address - Country:US
Mailing Address - Phone:480-343-1576
Mailing Address - Fax:
Practice Address - Street 1:205 E SOUTHERN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5400
Practice Address - Country:US
Practice Address - Phone:480-343-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158592; AP7980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily