Healthcare Provider Details

I. General information

NPI: 1063399707
Provider Name (Legal Business Name): SHANNON OHRSTROM CPRS,LPNOHIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 SCIOTO TRL
PORTSMOUTH OH
45662-2500
US

IV. Provider business mailing address

2716 SCIOTO TRL
PORTSMOUTH OH
45662-2500
US

V. Phone/Fax

Practice location:
  • Phone: 740-981-5785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: