Healthcare Provider Details

I. General information

NPI: 1982881421
Provider Name (Legal Business Name): SHANNON ROCHELLE NORMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 312
ANCHORAGE AK
99508-5231
US

IV. Provider business mailing address

4100 LAKE OTIS PKWY STE 312
ANCHORAGE AK
99508-5231
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-3773
  • Fax: 907-929-7330
Mailing address:
  • Phone: 907-929-7337
  • Fax: 907-929-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number7357
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: