Basic Information
| Provider Information | |||||||||
| NPI: | 1497014443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JOETTA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | VN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4974 EL CAJON BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166675271 | ||||||||
| FaxNumber: | 6192860060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4974 EL CAJON BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921154654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166675271 | ||||||||
| FaxNumber: | 6192860060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2012 | ||||||||
| LastUpdateDate: | 05/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN 195168 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.