Healthcare Provider Details

I. General information

NPI: 1326787938
Provider Name (Legal Business Name): MARY SHANNON HUFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER 17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

IV. Provider business mailing address

2060 MINGO RD
CHILLICOTHEE OH
45601-7542
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax:
Mailing address:
  • Phone: 740-773-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN261170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: