Basic Information
| Provider Information | |||||||||
| NPI: | 1982881421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORMAN | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | ROCHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 LAKE OTIS PKWY STE 312 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995085231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079297337 | ||||||||
| FaxNumber: | 9079297330 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 LAKE OTIS PKWY STE 312 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995085231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079293773 | ||||||||
| FaxNumber: | 9079297330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 7357 | AK | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1576741 | 05 | AK | MEDICAID |