Healthcare Provider Details

I. General information

NPI: 1679495444
Provider Name (Legal Business Name): NAKITA MARIE BROWN CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20895 SW MARTINI CT
BEAVERTON OR
97078-4050
US

IV. Provider business mailing address

1027 E BURNSIDE ST
PORTLAND OR
97214-1328
US

V. Phone/Fax

Practice location:
  • Phone: 971-369-5492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: