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General NPI Number Information
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NPI Number | 1639914294
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Entity Type | Individual
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Provider Name | BIANCA CHANNEL BROWN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1880 N ORANGE GROVE AVE
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City | POMONA
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State | CA
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Zip | 91767-3006
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Country | US
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Telephone | 909-620-7200
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Fax | 909-620-5800
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Provider Business Mailing Address
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Address Line | 840 TOWNE CENTER DR
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City | POMONA
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State | CA
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Zip | 91767-5900
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Country | US
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Telephone | 909-398-1550
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95203758
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95030821
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License Number State | CA
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