Healthcare Provider Details

I. General information

NPI: 1649534058
Provider Name (Legal Business Name): SHANNON N POWERS MSN, CRNP, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WHITE POND DR
AKRON OH
44320-1155
US

IV. Provider business mailing address

701 WHITE POND DR
AKRON OH
44320-1155
US

V. Phone/Fax

Practice location:
  • Phone: 330-926-3322
  • Fax: 330-926-3342
Mailing address:
  • Phone: 330-926-3322
  • Fax: 330-926-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA13463-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number290743
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: