Healthcare Provider Details

I. General information

NPI: 1134754799
Provider Name (Legal Business Name): SHANNAN RENEE BILLINGSLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6045 WALDWAY LN
CINCINNATI OH
45224-2751
US

IV. Provider business mailing address

6045 WALDWAY LN
CINCINNATI OH
45224-2751
US

V. Phone/Fax

Practice location:
  • Phone: 513-884-0465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.284421
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: