Provider Demographics
NPI:1225851835
Name:BROWN, JESSICA (STNA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 BRICE RD UNIT 378
Mailing Address - Street 2:
Mailing Address - City:BRICE
Mailing Address - State:OH
Mailing Address - Zip Code:43109-7520
Mailing Address - Country:US
Mailing Address - Phone:313-930-7198
Mailing Address - Fax:
Practice Address - Street 1:175 S 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5194
Practice Address - Country:US
Practice Address - Phone:614-662-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant