Healthcare Provider Details

I. General information

NPI: 1942725130
Provider Name (Legal Business Name): SHANNON DRISCOLL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CLIFTON AVE STE 305
CINCINNATI OH
45220-3047
US

IV. Provider business mailing address

2930 MARKBREIT AVE APT 1
CINCINNATI OH
45209-2080
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-1270
  • Fax: 513-489-1526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0032857
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number442583
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: