Healthcare Provider Details

I. General information

NPI: 1093470759
Provider Name (Legal Business Name): SHAWN C NORMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0317
US

IV. Provider business mailing address

7555 WARREN PKWY APT 377
FRISCO TX
75034-0317
US

V. Phone/Fax

Practice location:
  • Phone: 202-247-6841
  • Fax:
Mailing address:
  • Phone: 252-258-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number184823
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP1002219
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: