MEDICARE: MRS. JOLINDA LOU BROWN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN.0043138	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN.0043138	OTHER	CO	DORA

General Provider Information

NPI Number	:	1477223923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOLINDA LOU BROWN LPN

Provider Business Mailing Address
First Line	:	312 W 3RD ST
Second Line	:
City	:	FLORENCE
State	:	CO
Zip	:	81226-1410
Country	:	US
Telephone Number	:	719-339-9596
Fax Number	:	719-526-2998

Provider Business Practice Location Address
First Line	:	2751 WILDERNESS RD BLDG 9481
Second Line	:
City	:	FT CARSON
State	:	CO
Zip	:	80913-4719
Country	:	US
Telephone Number	:	719-526-5142
Fax Number	:	719-526-2998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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