Provider Demographics
NPI:1184164147
Name:BROWN-HIGGINS, JOHNIECE
Entity type:Individual
Prefix:
First Name:JOHNIECE
Middle Name:
Last Name:BROWN-HIGGINS
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 1:4517 BUFORT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5583
Mailing Address - Country:US
Mailing Address - Phone:937-867-7866
Mailing Address - Fax:
Practice Address - Street 1:4517 BUFORT BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5583
Practice Address - Country:US
Practice Address - Phone:937-867-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN153357MED-IV164W00000X, 374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel