Provider Demographics
NPI:1063897890
Name:NABET, BRIANNE WALTERS (MPA, PA-C)
Entity type:Individual
Prefix:MS
First Name:BRIANNE
Middle Name:WALTERS
Last Name:NABET
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:57870 JUAREZ DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-4443
Mailing Address - Country:US
Mailing Address - Phone:301-606-8464
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3046
Practice Address - Country:US
Practice Address - Phone:951-845-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-07554OtherNC STATE LICENSE
VA0110005036OtherVA STATE LICENSE
CA55779OtherCA STATE LICENSE