Healthcare Provider Details

I. General information

NPI: 1831343011
Provider Name (Legal Business Name): LINDA RAE BROWN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 MESQUITE DR
SANTA ROSA CA
95405-8310
US

IV. Provider business mailing address

17385 PARK AVE
SONOMA CA
95476-8508
US

V. Phone/Fax

Practice location:
  • Phone: 707-542-6272
  • Fax: 707-544-0360
Mailing address:
  • Phone: 707-332-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number217162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number217162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: