Healthcare Provider Details

I. General information

NPI: 1679684153
Provider Name (Legal Business Name): ELISSA E BROWN MSN,APRN,BC,CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BLDG 258, RM 201
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD BLDG 258, RM 201
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4829
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number302710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: