Provider Demographics
NPI:1982057139
Name:BROWN, JENIFER (RDH, PHRDH)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH, PHRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:ELM CREEK
Mailing Address - State:NE
Mailing Address - Zip Code:68836-7631
Mailing Address - Country:US
Mailing Address - Phone:308-440-3436
Mailing Address - Fax:
Practice Address - Street 1:230 S TYLER ST
Practice Address - Street 2:
Practice Address - City:ELM CREEK
Practice Address - State:NE
Practice Address - Zip Code:68836-7631
Practice Address - Country:US
Practice Address - Phone:308-440-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1203124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist