Provider Demographics
NPI:1871714584
Name:BROWN, MARY JO (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:7500 FIREWEED CIR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3281
Mailing Address - Country:US
Mailing Address - Phone:916-847-4565
Mailing Address - Fax:562-612-0398
Practice Address - Street 1:3200 E 19TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90755-1244
Practice Address - Country:US
Practice Address - Phone:562-494-7687
Practice Address - Fax:562-494-7817
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA229020163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice