Individual
MS. BRIANNE WALTERS NABET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPA, PA-C
Contact information
Practice address
600 N HIGHLAND SPRINGS AVE, BANNING, CA 92220-3046
(951) 845-1121
Mailing address
57870 JUAREZ DR, YUCCA VALLEY, CA 92284-4443
(301) 606-8464
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-005036
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-07554
NC STATE LICENSE
NC
01
—
0110005036
VA STATE LICENSE
VA
01
—
55779
CA STATE LICENSE
CA
Enumeration date
07/22/2015
Last updated
12/13/2018
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