Provider Demographics
NPI:1841747003
Name:BROWN, SHANTA RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:SHANTA
Middle Name:RENEE
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 1:1149 SHERBURNE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2945
Mailing Address - Country:US
Mailing Address - Phone:651-500-0698
Mailing Address - Fax:
Practice Address - Street 1:1149 SHERBURNE AVE APT 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2945
Practice Address - Country:US
Practice Address - Phone:651-500-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 224980-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse