Healthcare Provider Details

I. General information

NPI: 1932292596
Provider Name (Legal Business Name): JAMES GERARD BROWN C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FOOTE HOSP., 205 NORTH EAST AVENUE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

2100 MERRILL RD.
MASON MI
48854
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4963
  • Fax:
Mailing address:
  • Phone: 517-282-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704122233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: