MEDICARE: CAROL L. BROWN RNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	257248	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	257248	OTHER	CA	RNP LICENSE

General Provider Information

NPI Number	:	1366442386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L. BROWN RNP

Provider Business Mailing Address
First Line	:	3123 AMIGOS DRIVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504
Country	:	US
Telephone Number	:	818-424-3780
Fax Number	:

Provider Business Practice Location Address
First Line	:	13652 CANTARA ST
Second Line	:	POPULATION CARE SOUTH 1
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5423
Country	:	US
Telephone Number	:	818-424-3780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	05/19/2010

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