Provider Demographics
NPI:1205816949
Name:BRIGANCE, SHAWN FITZGERALD (ARNP)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:FITZGERALD
Last Name:BRIGANCE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:MR
Other - First Name:SHAWN
Other - Middle Name:FITZGERALD
Other - Last Name:BRIGANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:500 KIRTS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4135
Mailing Address - Country:US
Mailing Address - Phone:248-434-6169
Mailing Address - Fax:
Practice Address - Street 1:444 E POLK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-653-6601
Practice Address - Fax:319-653-5624
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ146927363L00000X
KS53-44831-101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100347540AMedicaid
KS100347540AMedicaid
824694512Medicare PIN
824694512Medicare ID - Type Unspecified