1942852033 NPI number — JESSICA HELEN-MARIE BROWN CTRS

Table of content: JESSICA HELEN-MARIE BROWN CTRS (NPI 1942852033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942852033 NPI number — JESSICA HELEN-MARIE BROWN CTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JESSICA
Provider Middle Name:
HELEN-MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CTRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942852033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 LA BELLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-2831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-612-5289
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39393 VAN DYKE AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48313-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-722-7524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225800000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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