Healthcare Provider Details

I. General information

NPI: 1427575588
Provider Name (Legal Business Name): CHANELL BROWN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

IV. Provider business mailing address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

V. Phone/Fax

Practice location:
  • Phone: 510-260-9581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number728745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: