Healthcare Provider Details

I. General information

NPI: 1053757971
Provider Name (Legal Business Name): SHANNON MARIE GREAKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON M. GRAMS APRN-CNP

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 10TH AVE FL 1
COLUMBUS OH
43210-1280
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5066
  • Fax: 614-293-9449
Mailing address:
  • Phone: 614-293-5066
  • Fax: 614-293-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.14768
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.14768
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: