Healthcare Provider Details

I. General information

NPI: 1518654797
Provider Name (Legal Business Name): JENNIFER MOREE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 W MARKET ST
AKRON OH
44303-1438
US

IV. Provider business mailing address

665 W MARKET ST
AKRON OH
44303-1438
US

V. Phone/Fax

Practice location:
  • Phone: 234-255-0743
  • Fax: 330-379-3465
Mailing address:
  • Phone: 234-255-0743
  • Fax: 330-379-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberOCPSA.3693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: