MEDICARE: MRS. SHANN TEEN CHANCE

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	163WG0000X	General Practice Registered Nurse	363678	OH

General Provider Information

NPI Number	:	1023448719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANN TEEN CHANCE

Provider Business Mailing Address
First Line	:	10928 LINCOLN ST SE
Second Line	:
City	:	EAST CANTON
State	:	OH
Zip	:	44730-9348
Country	:	US
Telephone Number	:	330-205-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	10928 LINCOLN ST SE
Second Line	:
City	:	EAST CANTON
State	:	OH
Zip	:	44730-9348
Country	:	US
Telephone Number	:	330-205-2140
Fax Number	:

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/18/2013

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Directions to “ MRS. SHANN TEEN CHANCE ” Practice Location

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