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General NPI Number Information
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NPI Number | 1508760141
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Entity Type | Individual
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Provider Name | SHANE THOMAS BRANSON
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Gender | Male
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 21810 NE 37TH AVE
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City | RIDGEFIELD
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State | WA
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Zip | 98642-7747
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Country | US
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Telephone | 360-687-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 12014 NW 19TH CT
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City | VANCOUVER
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State | WA
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Zip | 98685-2475
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Country | US
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Telephone | 509-637-3746
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | WA
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