Healthcare Provider Details

I. General information

NPI: 1477560290
Provider Name (Legal Business Name): NANCY BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

917 OAKDALE RD
MODESTO CA
95355-4593
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-8400
  • Fax:
Mailing address:
  • Phone: 209-558-7248
  • Fax: 209-558-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: