Provider Demographics
NPI:1073548137
Name:BROWN, JACQUELINE E (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:ELAINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:23719 COX ROAD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-6878
Mailing Address - Country:US
Mailing Address - Phone:804-861-9499
Mailing Address - Fax:
Practice Address - Street 1:111 MORTEN AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2749
Practice Address - Country:US
Practice Address - Phone:804-862-8004
Practice Address - Fax:804-862-6158
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001104556163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse