Healthcare Provider Details

I. General information

NPI: 1992269328
Provider Name (Legal Business Name): ANGELA AMY BROWN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12414 S ANDRUS RD
CHENEY WA
99004-8607
US

IV. Provider business mailing address

1506 5TH ST
CHENEY WA
99004-1830
US

V. Phone/Fax

Practice location:
  • Phone: 509-559-4599
  • Fax:
Mailing address:
  • Phone: 509-290-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number60221132
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: