Healthcare Provider Details

I. General information

NPI: 1184164147
Provider Name (Legal Business Name): JOHNIECE BROWN-HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 BUFORT BLVD
DAYTON OH
45424-5583
US

IV. Provider business mailing address

4517 BUFORT BLVD
DAYTON OH
45424-5583
US

V. Phone/Fax

Practice location:
  • Phone: 937-867-7866
  • Fax:
Mailing address:
  • Phone: 937-867-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberLPN153357MED-IV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN153357MED-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: