Healthcare Provider Details

I. General information

NPI: 1790456069
Provider Name (Legal Business Name): SHANNAH NICOLE SPEARS STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 09/25/2021
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 TOMAHAWK ST
AKRON OH
44305-1031
US

IV. Provider business mailing address

1280 TOMAHAWK ST
AKRON OH
44305-1031
US

V. Phone/Fax

Practice location:
  • Phone: 330-524-5004
  • Fax:
Mailing address:
  • Phone: 330-524-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number410993670817
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: