Provider Demographics
NPI:1982881421
Name:NORMAN, SHANNON ROCHELLE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROCHELLE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY STE 312
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5231
Mailing Address - Country:US
Mailing Address - Phone:907-929-7337
Mailing Address - Fax:907-929-7330
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 312
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5231
Practice Address - Country:US
Practice Address - Phone:907-929-3773
Practice Address - Fax:907-929-7330
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK73572080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1576741Medicaid
AK1576741Medicaid