Provider Demographics
NPI:1841018348
Name:BROWN, JALIYAH LANET
Entity type:Individual
Prefix:
First Name:JALIYAH
Middle Name:LANET
Last Name:BROWN
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 1:1000 HILLCREST DR E APT 1022
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1612
Mailing Address - Country:US
Mailing Address - Phone:304-395-7475
Mailing Address - Fax:
Practice Address - Street 1:1000 HILLCREST DR E APT 1022
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1612
Practice Address - Country:US
Practice Address - Phone:304-395-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant