Provider Demographics
NPI:1760773899
Name:BROWN, JEANAN PAIGE (LMP)
Entity Type:Individual
Prefix:
First Name:JEANAN
Middle Name:PAIGE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5248
Mailing Address - Country:US
Mailing Address - Phone:253-569-5916
Mailing Address - Fax:
Practice Address - Street 1:330 15TH ST NW
Practice Address - Street 2:L202
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5248
Practice Address - Country:US
Practice Address - Phone:253-569-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60203917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist