Basic Information
Provider Information | |||||||||
NPI: | 1578601837 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BROWN | ||||||||
FirstName: | RITA | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NURSE PRACTITIONER | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 276 FIELDSTONE DR | ||||||||
Address2: |   | ||||||||
City: | JONESVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 242631215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2765463001 | ||||||||
FaxNumber: | 2765469705 | ||||||||
Practice Location | |||||||||
Address1: | 276 FIELDSTONE DR | ||||||||
Address2: |   | ||||||||
City: | JONESVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 242631215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2765463001 | ||||||||
FaxNumber: | 2765469705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/01/2007 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0017000983 | VA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 010130662 | 05 | VA |   | MEDICAID |