Individual
MRS. SHANNON BOOTHE BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7658
(318) 330-7648
Mailing address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7658
(318) 330-7648
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP06290
LA
363LF0000X
Family Nurse Practitioner
R853766
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2136607
—
LA
Enumeration date
09/16/2010
Last updated
09/26/2012
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