Provider Demographics
NPI:1881709038
Name:BROWN, SALLY LUCILLE (PA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:LUCILLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46314 TIMINE WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9417
Mailing Address - Country:US
Mailing Address - Phone:541-240-8548
Mailing Address - Fax:541-240-8750
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9417
Practice Address - Country:US
Practice Address - Phone:541-240-8548
Practice Address - Fax:541-240-8750
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60002097363A00000X
UT5173269-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant