Healthcare Provider Details

I. General information

NPI: 1275443608
Provider Name (Legal Business Name): JENNIFER RUTH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30526 REGAL AVE
SHAFER MN
55074-2314
US

IV. Provider business mailing address

30526 REGAL AVE
SHAFER MN
55074-2314
US

V. Phone/Fax

Practice location:
  • Phone: 305-492-9105
  • Fax:
Mailing address:
  • Phone: 305-492-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number10753822
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: