Basic Information
| Provider Information | |||||||||
| NPI: | 1093988867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | IBCLC, RLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4501 CAMERON VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282113546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043677400 | ||||||||
| FaxNumber: | 7043677444 | ||||||||
| Practice Location | |||||||||
| Address1: | 4501 CAMERON VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282113546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043677400 | ||||||||
| FaxNumber: | 7043677444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | 191-10659 | NC | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.