Healthcare Provider Details

I. General information

NPI: 1649940271
Provider Name (Legal Business Name): JESSICA M. BROWN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 GEORGIAN TER
LAKEWOOD NJ
08701-1644
US

IV. Provider business mailing address

1450 GEORGIAN TER
LAKEWOOD NJ
08701-1644
US

V. Phone/Fax

Practice location:
  • Phone: 732-597-3822
  • Fax:
Mailing address:
  • Phone: 732-597-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ01139500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: