Healthcare Provider Details

I. General information

NPI: 1902583438
Provider Name (Legal Business Name): SHANNON MARIE MILLIKEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N CANFIELD NILES RD STE 110
AUSTINTOWN OH
44515-2332
US

IV. Provider business mailing address

PO BOX 1098
DALLAS NC
28034-1098
US

V. Phone/Fax

Practice location:
  • Phone: 307-980-4913
  • Fax: 330-303-4948
Mailing address:
  • Phone: 330-798-0491
  • Fax: 330-303-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0034239
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: