Healthcare Provider Details

I. General information

NPI: 1508661638
Provider Name (Legal Business Name): SHANNON MICHAEL LINTON BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 OH 104
CHILLICOTHEE OH
45601-4560
US

IV. Provider business mailing address

116 S SHORE DR
CHILLICOTHEE OH
45601-2060
US

V. Phone/Fax

Practice location:
  • Phone: 740-637-5926
  • Fax:
Mailing address:
  • Phone: 740-637-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN396587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: