Healthcare Provider Details

I. General information

NPI: 1306386834
Provider Name (Legal Business Name): MONISHA SHANI BROWN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONISHA BOATMAN

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MDG (18TH MEDICAL GROUP) UNIT 5142
APO AP
96368
US

IV. Provider business mailing address

18 MDG (18TH MEDICAL GROUP) UNIT 5142
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 315-554-1996
  • Fax:
Mailing address:
  • Phone: 315-554-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197841
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number22576
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number22576
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: