Provider Demographics
NPI:1760592596
Name:BROW, SHAWN JV (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:JV
Last Name:BROW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30306
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3005
Mailing Address - Country:US
Mailing Address - Phone:509-939-6069
Mailing Address - Fax:509-228-9542
Practice Address - Street 1:526 N MULLAN RD STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-2407
Practice Address - Country:US
Practice Address - Phone:509-924-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001992367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9617747Medicaid
WA000382013Medicare ID - Type Unspecified