Healthcare Provider Details

I. General information

NPI: 1578002986
Provider Name (Legal Business Name): SHANNON SAXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 CHURCHILL HUBBARD RD
YOUNGSTOWN OH
44505-1332
US

IV. Provider business mailing address

615 CHURCHILL HUBBARD RD
YOUNGSTOWN OH
44505-1332
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-2700
  • Fax:
Mailing address:
  • Phone: 330-759-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN 327258
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: