Healthcare Provider Details

I. General information

NPI: 1881717403
Provider Name (Legal Business Name): TERESA SUE SHINN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 JESSICA LN
CELINA OH
45822-8714
US

IV. Provider business mailing address

1228 JESSICA LN
CELINA OH
45822-8714
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-1024
  • Fax: 419-586-7145
Mailing address:
  • Phone: 419-586-1024
  • Fax: 419-586-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-185959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: