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General NPI Number Information
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NPI Number | 1871119198
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Entity Type | Individual
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Provider Name | JESSICA LYNN BROWN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 200 S ORANGE AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5817
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Country | US
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Telephone | 609-405-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 508 FERN AVE
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City | HADDON TOWNSHIP
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State | NJ
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Zip | 08108-2229
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Country | US
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Telephone | 609-405-9146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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