Basic Information
| Provider Information | |||||||||
| NPI: | 1871118810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | MILAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 ARK RD | ||||||||
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| City: | LOTHIAN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207112905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405658507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 LEE AIRPARK DR # 400 | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210371229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436071469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.