Provider Demographics
NPI:1871230664
Name:BROWN, JONATHAN DWAYNE I
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DWAYNE
Last Name:BROWN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-3049
Mailing Address - Country:US
Mailing Address - Phone:219-302-5274
Mailing Address - Fax:
Practice Address - Street 1:11 APPLE LN
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2054
Practice Address - Country:US
Practice Address - Phone:708-506-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide