Healthcare Provider Details

I. General information

NPI: 1679296347
Provider Name (Legal Business Name): NI'YESHA MONET BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4291 N MILLBROOK AVE
FRESNO CA
93726-3438
US

IV. Provider business mailing address

7120 N MARKS AVE
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-7967
  • Fax:
Mailing address:
  • Phone: 559-439-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: