Healthcare Provider Details

I. General information

NPI: 1689099244
Provider Name (Legal Business Name): ROWENA AFABLEMARSH BRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 65TH ST
SACRAMENTO CA
95820-3329
US

IV. Provider business mailing address

4721 65TH ST
SACRAMENTO CA
95820-3329
US

V. Phone/Fax

Practice location:
  • Phone: 916-580-5683
  • Fax:
Mailing address:
  • Phone: 916-580-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number777937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: