Provider Demographics
NPI:1972228765
Name:BROWN, JONATHAN LUKE (RD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LUKE
Last Name:BROWN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 RING NECK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1476
Mailing Address - Country:US
Mailing Address - Phone:607-331-5621
Mailing Address - Fax:
Practice Address - Street 1:4450 OAKHURST BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3452
Practice Address - Country:US
Practice Address - Phone:717-788-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86150075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86150075OtherRDN REGISTRATION NUMBER