Provider Demographics
NPI:1437273257
Name:BROWN, JIL HUMBERGER
Entity Type:Individual
Prefix:
First Name:JIL
Middle Name:HUMBERGER
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1918
Mailing Address - Country:US
Mailing Address - Phone:252-823-6333
Mailing Address - Fax:252-823-1406
Practice Address - Street 1:2704 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1918
Practice Address - Country:US
Practice Address - Phone:252-823-6333
Practice Address - Fax:252-823-1406
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0200552363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology