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1043963309 NPI number — SHANNON MARIE BROWN ATC, LAT, MS, CPT

NPI Number: 1043963309
Health Care Provider/Practitioner: SHANNON MARIE BROWN ATC, LAT, MS, CPT

Information about “1043963309” NPI (SHANNON MARIE BROWN ATC, LAT, MS, CPT) exists in 1043963309 in HTML format HTML  |  1043963309 in plain Text format TXT  |  1043963309 in PDF (Portable Document Format) PDF  |  1043963309 in an XML format XML  formats.

NPI Number : 1043963309 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043963309",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROWN",
    "FirstName": "SHANNON",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC, LAT, MS, CPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11710 FAIRFAX WOODS WAY APT 21305",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRFAX",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22030-8334",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-832-0972",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11204 BRADDOCK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRFAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22030-5405",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-832-0972",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/27/2022",
    "LastUpdateDate": "12/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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