Yulandist Jeannie Brown, LPN, LMT

Individual provider Active NPI Licensed Practical Nurse · Ottawa, IL

NPI 1306336359 · NPPES record last updated May 15, 2018

Key facts

NPI
1306336359
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
043.121878 (IL)
Practice address
617 Columbus St
Ottawa, IL 61350
Phone
(815) 579-8962
NPI assigned
May 15, 2018
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
043.121878ILMDLicensed Practical Nurse
227.019508ILMDMassage Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 227.019508 IL
Licensed Practical Nurse 164W00000X 043.121878 IL Yes

Addresses

Primary practice location

617 Columbus St
Ottawa, IL 61350

Mailing address

617 Columbus St
Ottawa, IL 61350-2912
Phone (815) 579-8962

Other providers in Ottawa, IL

All providers in Ottawa, IL · Licensed Practical Nurse in Illinois

Sources for this page

Verify at the official NPI Registry.