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General NPI Number Information
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NPI Number | 1346647278
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Entity Type | Individual
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Provider Name | SHANNON BROOKE ANGEL NCTMB, RYT-200
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Gender | Female
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 169 SNOWY MOUNTAIN CIRCLE
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City | BIG SKY
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State | MT
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Zip | 59716
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Country | US
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Telephone | 918-902-5095
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Fax |
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Provider Business Mailing Address
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Address Line | 90 W MADISON AVE SUITE-245
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City | BELGRADE
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State | MT
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Zip | 59714-3955
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Country | US
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Telephone | 918-902-5095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 0016656
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 8079
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License Number State | MT
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