Provider Demographics
NPI:1346647278
Name:ANGEL, SHANNON BROOKE (NCTMB, RYT-200)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BROOKE
Last Name:ANGEL
Suffix:
Gender:F
Credentials:NCTMB, RYT-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W MADISON AVE
Mailing Address - Street 2:SUITE-245
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3955
Mailing Address - Country:US
Mailing Address - Phone:918-902-5095
Mailing Address - Fax:
Practice Address - Street 1:169 SNOWY MOUNTAIN CIRCLE
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716
Practice Address - Country:US
Practice Address - Phone:918-902-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016656171W00000X
MT8079171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor