=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316354608
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON BAXTER CNM, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2014
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 W UNION ST
-----------------------------------------------------
City | LIGONIER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46767-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-265-8382
-----------------------------------------------------
Fax | 574-971-4264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 W UNION ST
-----------------------------------------------------
City | LIGONIER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46767-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-265-8382
-----------------------------------------------------
Fax | 574-971-4264
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 09000246A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 09000246A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------