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General NPI Number Information
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NPI Number | 1669294039
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Entity Type | Individual
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Provider Name | SHANA L BROWN CNP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1325 N DICKINSON DR
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City | RUSK
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State | TX
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Zip | 75785-1051
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Country | US
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Telephone | 903-683-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 10425 COUNTY ROAD 2180
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City | WHITEHOUSE
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State | TX
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Zip | 75791-5934
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Country | US
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Telephone | 903-571-2141
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1178573
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License Number State | TX
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