Provider Demographics
NPI:1023734142
Name:BROWN, JANISE
Entity type:Individual
Prefix:
First Name:JANISE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANISE
Other - Middle Name:LA'CHELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1651 MENTOR AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1724
Mailing Address - Country:US
Mailing Address - Phone:440-637-6272
Mailing Address - Fax:
Practice Address - Street 1:1651 MENTOR AVE APT 108
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1724
Practice Address - Country:US
Practice Address - Phone:440-637-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0370844Medicaid