Provider Demographics
NPI:1184992232
Name:BRIGHTEN, JEWEL (CPM, LM)
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:BRIGHTEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4410
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-2729
Mailing Address - Country:US
Mailing Address - Phone:928-642-4383
Mailing Address - Fax:
Practice Address - Street 1:890 STALEY LN
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-6173
Practice Address - Country:US
Practice Address - Phone:928-642-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0206176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY140192100Medicaid