MEDICARE: MARY JO BROWN RN

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	163WH1000X	Hospice Registered Nurse	229020	CA

General Provider Information

NPI Number	:	1871714584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO BROWN RN

Provider Business Mailing Address
First Line	:	7500 FIREWEED CIR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3281
Country	:	US
Telephone Number	:	916-847-4565
Fax Number	:	562-612-0398

Provider Business Practice Location Address
First Line	:	3200 E 19TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90755-1244
Country	:	US
Telephone Number	:	562-494-7687
Fax Number	:	562-494-7817

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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Directions to “ MARY JO BROWN RN” Practice Location

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