MEDICARE: SHANNON MARIE BROWN PA-C

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	363A00000X	Physician Assistant	5601003706	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970023780	OTHER	MI	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1821027269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARIE BROWN PA-C

Provider Business Mailing Address
First Line	:	5515 CLEVELAND AVE
Second Line	:	SUITE 5
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9670
Country	:	US
Telephone Number	:	269-429-9644
Fax Number	:	269-429-4002

Provider Business Practice Location Address
First Line	:	5515 CLEVELAND AVE
Second Line	:	SUITE 5
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9670
Country	:	US
Telephone Number	:	269-429-9644
Fax Number	:	269-429-4002

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/14/2013

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Directions to “ SHANNON MARIE BROWN PA-C” Practice Location

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