Provider Demographics
NPI:1932179520
Name:BROWN, JEAN R (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1201 NOTT STREET
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-243-3388
Mailing Address - Fax:518-243-1329
Practice Address - Street 1:1201 NOTT STREET
Practice Address - Street 2:SUITE 307
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-243-3388
Practice Address - Fax:518-243-1329
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY300222363LA2200X
NY331304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY500015186OtherRR MEDICARE
NY040426006783OtherFIDELIS
NY318476OtherMVP
NY000494228001OtherBLUE SHIELD
11464152OtherCAQH
NY0000000692111OtherGHI HMO
NY00347562Medicaid
NY7599230OtherPPOGHI
NY0000000692111OtherGHI HMO
NY000494228001OtherBLUE SHIELD