Healthcare Provider Details

I. General information

NPI: 1598956559
Provider Name (Legal Business Name): JENNIFER MARIE BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 3RD ST NW
ELK RIVER MN
55330
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4400
  • Fax: 763-587-4885
Mailing address:
  • Phone: 763-587-4800
  • Fax: 763-587-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61428
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: