Provider Demographics
NPI:1700981867
Name:STRUBHAR-BROWN, MARY JOANNE (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOANNE
Last Name:STRUBHAR-BROWN
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 W FOOTHILL BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3806
Mailing Address - Country:US
Mailing Address - Phone:909-982-4000
Mailing Address - Fax:909-981-7800
Practice Address - Street 1:299 W FOOTHILL BLVD STE 209
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3806
Practice Address - Country:US
Practice Address - Phone:909-982-4000
Practice Address - Fax:909-981-7800
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA311328OtherSTATE LICENSE
CAMS0590326OtherDEA #