Provider Demographics
NPI:1497012389
Name:BROWN, JEAN MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PRICEMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4325
Mailing Address - Country:US
Mailing Address - Phone:314-994-9410
Mailing Address - Fax:
Practice Address - Street 1:12303 DEPAUL DRIVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63044-2588
Practice Address - Country:US
Practice Address - Phone:314-344-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001322133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered