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General NPI Number Information
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NPI Number | 1508048737
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Entity Type | Individual
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Provider Name | SHANNON M KIDD CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 401 MATTHEW ST
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City | MARIETTA
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State | OH
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Zip | 45750-1635
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Country | US
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Telephone | 740-374-9990
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Fax | 740-374-9993
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Provider Business Mailing Address
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Address Line | 2139 AUBURN AVE
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 740-374-4500
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Fax | 740-374-5887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 60137
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COA.11504.NA
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License Number State | OH
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