Healthcare Provider Details

I. General information

NPI: 1174038491
Provider Name (Legal Business Name): LUIZA MARIA BROWN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7632 SW DURHAM RD STE 130
TIGARD OR
97224-7584
US

IV. Provider business mailing address

7632 SW DURHAM RD STE 130
TIGARD OR
97224-7584
US

V. Phone/Fax

Practice location:
  • Phone: 800-936-4756
  • Fax:
Mailing address:
  • Phone: 800-936-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number634693
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number634693
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number201807431NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: