Healthcare Provider Details

I. General information

NPI: 1235083809
Provider Name (Legal Business Name): JEAN BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 26 1/2 CT S
FARGO ND
58103-6643
US

IV. Provider business mailing address

2107 26 1/2 CT S
FARGO ND
58103-6643
US

V. Phone/Fax

Practice location:
  • Phone: 701-535-0057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: