Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024178659 | VA |
NPI | 1013542349 |
---|---|
Provider Name | Ms. Juliet Brown |
First Address | Landover, MD 20785-4741 |
Second Address | Alexandria, VA 22304-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2020 |
Last Update Date | 06/03/2020 |