Provider Demographics
NPI:1245499466
Name:BROWN SHRADER, JANELL (LMP)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:BROWN SHRADER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 GOLDENROD PL NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3986
Mailing Address - Country:US
Mailing Address - Phone:360-990-4626
Mailing Address - Fax:
Practice Address - Street 1:1970 NE FUSON RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3727
Practice Address - Country:US
Practice Address - Phone:360-792-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024304225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist