Healthcare Provider Details

I. General information

NPI: 1174763239
Provider Name (Legal Business Name): JENNIFER MARIE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RIVER VALLEY BLVD
LANCASTER OH
43130-1653
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-2273
  • Fax: 740-687-9059
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.001390RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: