1154486686 NPI number — MRS. JESSICA DAWN BROWN PA-C

Table of content: MRS. JESSICA DAWN BROWN PA-C (NPI 1154486686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154486686 NPI number — MRS. JESSICA DAWN BROWN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JESSICA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FINLEY
Provider Other First Name:
JESSICA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154486686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2955 VALMONT RD
Provider Second Line Business Mailing Address:
SUITE # 210
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-1396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-440-7525
Provider Business Mailing Address Fax Number:
303-440-4215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 W 38TH AVE
Provider Second Line Business Practice Location Address:
LUTHERAN MEDICAL CENTER E.D.
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-6005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-440-7525
Provider Business Practice Location Address Fax Number:
303-440-4215
Provider Enumeration Date:
12/26/2006

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: 363A00000X , with the licence number:  1201 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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