Healthcare Provider Details

I. General information

NPI: 1154033561
Provider Name (Legal Business Name): SHANNON TERESA TREVINO RN, PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

908 BACCARAT DR
CINCINNATI OH
45245-1981
US

V. Phone/Fax

Practice location:
  • Phone: 513-314-1935
  • Fax:
Mailing address:
  • Phone: 513-314-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030029
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0030029
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: