Healthcare Provider Details

I. General information

NPI: 1659403996
Provider Name (Legal Business Name): JACQUELINE MARIE BROWN RN,MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENDALL DR
LAMAR CO
81052-3901
US

IV. Provider business mailing address

711 BARNES AVE
LA JUNTA CO
81050-2138
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-9154
  • Fax: 719-336-7453
Mailing address:
  • Phone: 716-384-5446
  • Fax: 719-384-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number72910
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: