Healthcare Provider Details

I. General information

NPI: 1720174147
Provider Name (Legal Business Name): JENNIFER ANN BROWN CRNA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20502 NE 190TH CIR
BRUSH PRAIRIE WA
98606-8813
US

IV. Provider business mailing address

20502 NE 190TH CIR
BRUSH PRAIRIE WA
98606-8813
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-4161
  • Fax: 360-892-4161
Mailing address:
  • Phone: 360-892-4161
  • Fax: 360-892-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30007451
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: