Healthcare Provider Details

I. General information

NPI: 1871714584
Provider Name (Legal Business Name): MARY JO BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E 19TH ST
LONG BEACH CA
90755-1244
US

IV. Provider business mailing address

7500 FIREWEED CIR
CITRUS HEIGHTS CA
95610-3281
US

V. Phone/Fax

Practice location:
  • Phone: 562-494-7687
  • Fax: 562-494-7817
Mailing address:
  • Phone: 916-847-4565
  • Fax: 562-612-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number229020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: