Healthcare Provider Details

I. General information

NPI: 1750688198
Provider Name (Legal Business Name): NATIVIDA BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTCHESTER AVE
WHITE PLAINS NY
10604-2901
US

IV. Provider business mailing address

45 PUTNAM RD
CORTLANDT MANOR NY
10567-7443
US

V. Phone/Fax

Practice location:
  • Phone: 914-682-0700
  • Fax:
Mailing address:
  • Phone: 914-490-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: