Provider Demographics
NPI:1548408313
Name:JACKSON BROWN, MYA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:LYNN
Last Name:JACKSON BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BEDROCK RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-2110
Mailing Address - Country:US
Mailing Address - Phone:513-310-7764
Mailing Address - Fax:
Practice Address - Street 1:50 BEDROCK RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-2110
Practice Address - Country:US
Practice Address - Phone:513-310-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN288538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse