Provider Demographics
NPI:1376891259
Name:BROWN-JOERG, DONNA ANN
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ANN
Last Name:BROWN-JOERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:ANN
Other - Last Name:BROWN-JOERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:3709 MAIN ST
Mailing Address - Street 2:APT #3
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-3734
Mailing Address - Country:US
Mailing Address - Phone:802-777-8653
Mailing Address - Fax:
Practice Address - Street 1:3709 MAIN ST
Practice Address - Street 2:APT #3
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996-3734
Practice Address - Country:US
Practice Address - Phone:802-777-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282553-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse