Healthcare Provider Details

I. General information

NPI: 1053652289
Provider Name (Legal Business Name): SHANNON MARIE BROWN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E DUNLAP AVE
PHOENIX AZ
85020-2825
US

IV. Provider business mailing address

9225 N 3RD ST SUITE 300
PHOENIX AZ
85020-2439
US

V. Phone/Fax

Practice location:
  • Phone: 602-445-0751
  • Fax: 602-424-8128
Mailing address:
  • Phone: 602-445-0751
  • Fax: 602-424-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4920
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP4920
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: