Andrew Timothy Shofner

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

201343-3-AFC Issued in MN

Practice address

4849 4TH Ave
Brookston, MN 55711-0317

Phone

(218) 453-5037

NPI assigned

Jun 18, 2010

Last updated

Jun 18, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1124349790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 317",
            "city": "BROOKSTON",
            "state": "MN",
            "postal_code": "557110317",
            "telephone_number": "218-453-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4849 4TH AVE",
            "city": "BROOKSTON",
            "state": "MN",
            "postal_code": "557110317",
            "telephone_number": "218-453-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOFNER",
        "first_name": "ANDREW",
        "middle_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-18",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MN",
            "license": "201343-3-AFC",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MN",
            "license": "2013433AFC",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Manor Inc
• Abby Johnsen, NBCHWC
• Jennier Renee Johnson, PRESIDENT
• Peterson Colonial Homes, Inc.
• Sharon Shofner Adult Foster Care
• Stonehaven Assisted Living Inc.
• Transitions Plus, Inc.

• Case Manager/Care Coordinator in Brookston, MN
• Providers in Brookston, MN by specialty
• Case Manager/Care Coordinator in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.