MEDICARE: SHANNON NICHOLE JARRETT STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401490020213	OH

General Provider Information

NPI Number	:	1023898780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON NICHOLE JARRETT STNA

Provider Business Mailing Address
First Line	:	3669 E 114TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2537
Country	:	US
Telephone Number	:	216-622-5743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3669 E 114TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2537
Country	:	US
Telephone Number	:	216-622-5743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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