Provider Demographics
NPI:1154651529
Name:JOHNSON-BROWN, JILLIAN (LPN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:JOHNSON-BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 KIRKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3119
Mailing Address - Country:US
Mailing Address - Phone:516-502-2586
Mailing Address - Fax:516-502-2586
Practice Address - Street 1:263 KIRKMAN AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3119
Practice Address - Country:US
Practice Address - Phone:516-502-2586
Practice Address - Fax:516-502-2586
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297693-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse