Provider Demographics
NPI:1922363977
Name:BROWN, NENETTE (NP)
Entity Type:Individual
Prefix:
First Name:NENETTE
Middle Name:
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 1:165 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4795
Mailing Address - Country:US
Mailing Address - Phone:619-312-0347
Mailing Address - Fax:619-749-5480
Practice Address - Street 1:165 S 1ST ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4795
Practice Address - Country:US
Practice Address - Phone:619-312-0347
Practice Address - Fax:619-749-5480
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner