Provider Demographics
NPI:1184996464
Name:BROWN-REID, JENNIFER DENICE (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENICE
Last Name:BROWN-REID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16B PARDUN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3328
Mailing Address - Country:US
Mailing Address - Phone:732-485-9784
Mailing Address - Fax:
Practice Address - Street 1:16B PARDUN RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3328
Practice Address - Country:US
Practice Address - Phone:732-485-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06517500164W00000X
NY305680-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse