Provider Demographics
NPI:1417390949
Name:BROWN, JACQUELINE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ELIZABETH
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2450 SW PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4302
Mailing Address - Country:US
Mailing Address - Phone:541-276-1700
Mailing Address - Fax:541-276-6327
Practice Address - Street 1:2450 SW PERKINS AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-276-1700
Practice Address - Fax:541-276-6327
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORPA170722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program