Provider Demographics
NPI:1699820308
Name:BROWN, SHANNON LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LOUISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48365 GRABIARZ DR # 1
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1830
Mailing Address - Country:US
Mailing Address - Phone:254-213-4169
Mailing Address - Fax:
Practice Address - Street 1:31ST STREET & BATTALION AVE
Practice Address - Street 2:BUILDING 420
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-618-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163289163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care