Provider Demographics
NPI:1417236951
Name:BRINKMAN, SHANNON MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARIE
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 MEMPHIS AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2032
Mailing Address - Country:US
Mailing Address - Phone:440-503-7066
Mailing Address - Fax:
Practice Address - Street 1:9809 MEMPHIS AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2032
Practice Address - Country:US
Practice Address - Phone:440-503-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN-139319-M-IV164W00000X
NC75442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse