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General NPI Number Information
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NPI Number | 1003360108
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Entity Type | Individual
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Provider Name | ANISSA BROWN
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 1700 STANDIFORD AVE
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City | MODESTO
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State | CA
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Zip | 95350-6534
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Country | US
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Telephone | 209-676-3069
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 STANDIFORD AVE STE 355
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City | MODESTO
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State | CA
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Zip | 95350-6534
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Country | US
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Telephone | 858-735-2255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024174345
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95012827
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License Number State | CA
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