Healthcare Provider Details

I. General information

NPI: 1790175834
Provider Name (Legal Business Name): EVETTE SHANER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST SUITE 240
LIMA OH
45801-3990
US

IV. Provider business mailing address

PO BOX 636930
CINCINNATI OH
45263-6930
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-2686
  • Fax: 419-996-2687
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: