Healthcare Provider Details

I. General information

NPI: 1265456172
Provider Name (Legal Business Name): DEBORAH J BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 CREEKSIDE LOOP
YAKIMA WA
98908-3959
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-3263
  • Fax: 509-225-2702
Mailing address:
  • Phone: 509-248-3263
  • Fax: 509-225-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003453
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: