Healthcare Provider Details

I. General information

NPI: 1891355608
Provider Name (Legal Business Name): JENNY L BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/11/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 HIGHWAY 49 N
BEULAH ND
58523-6038
US

IV. Provider business mailing address

1312 HIGHWAY 49 N
BEULAH ND
58523-6038
US

V. Phone/Fax

Practice location:
  • Phone: 701-873-4445
  • Fax:
Mailing address:
  • Phone: 701-873-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: