Provider Demographics
NPI:1750778148
Name:BROWN, WANIKA
Entity type:Individual
Prefix:
First Name:WANIKA
Middle Name:
Last Name:BROWN
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 1:4820 BUSINESS CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1696
Mailing Address - Country:US
Mailing Address - Phone:707-427-1845
Mailing Address - Fax:707-427-1637
Practice Address - Street 1:4820 BUSINESS CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1696
Practice Address - Country:US
Practice Address - Phone:707-224-8266
Practice Address - Fax:707-427-1637
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSSVCQEYP172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker