Provider Demographics
NPI:1689762742
Name:BRANCH, SHAWANA S (PNP)
Entity Type:Individual
Prefix:MS
First Name:SHAWANA
Middle Name:S
Last Name:BRANCH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:SHAWANA
Other - Middle Name:S
Other - Last Name:BRANCH-ROWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:5471 DR MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-4265
Mailing Address - Country:US
Mailing Address - Phone:143-675-8203
Mailing Address - Fax:314-747-3338
Practice Address - Street 1:5471 DR MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-4265
Practice Address - Country:US
Practice Address - Phone:143-675-8203
Practice Address - Fax:314-747-3338
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155025363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429880107Medicaid