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General NPI Number Information
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NPI Number | 1497408645
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Entity Type | Individual
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Provider Name | BROOKE ALLISON SHAW RN
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Gender | Female
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 1390 MARKET ST STE 200
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-5404
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Country | US
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Telephone | 800-504-5360
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Fax |
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Provider Business Mailing Address
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Address Line | 163 MEADOW SPRING CT
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City | TEMPLE
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State | GA
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Zip | 30179-5090
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Country | US
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Telephone | 770-843-3529
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN279628
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License Number State | GA
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