MEDICARE: MS. SHANNON MARIE BRINKMAN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN-139319-M-IV	OH
2	164W00000X	Licensed Practical Nurse	75442	NC

General Provider Information

NPI Number	:	1417236951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON MARIE BRINKMAN LPN

Provider Business Mailing Address
First Line	:	9809 MEMPHIS AVE
Second Line	:	SUITE 10
City	:	BROOKLYN
State	:	OH
Zip	:	44144-2032
Country	:	US
Telephone Number	:	440-503-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	9809 MEMPHIS AVE
Second Line	:	SUITE 10
City	:	BROOKLYN
State	:	OH
Zip	:	44144-2032
Country	:	US
Telephone Number	:	440-503-7066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/09/2012

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