Provider Demographics
NPI:1255076923
Name:PULLIAM-BROWN, SHAWNTA' (BCNWP, CD(DONA))
Entity type:Individual
Prefix:
First Name:SHAWNTA'
Middle Name:
Last Name:PULLIAM-BROWN
Suffix:
Gender:F
Credentials:BCNWP, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 BRANDES ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-3002
Mailing Address - Country:US
Mailing Address - Phone:814-460-3205
Mailing Address - Fax:
Practice Address - Street 1:4906 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1978
Practice Address - Country:US
Practice Address - Phone:814-299-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 175L00000X
PA14594374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopath