MEDICARE: SHANNON REESE

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	374U00000X	Home Health Aide	101032630110	OH

General Provider Information

NPI Number	:	1184978199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON REESE

Provider Business Mailing Address
First Line	:	3050 MORIN POINT ST
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133
Country	:	US
Telephone Number	:	419-215-8817
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 MORIN POINT ST
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133-9685
Country	:	US
Telephone Number	:	419-215-8817
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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Directions to “ SHANNON REESE ” Practice Location

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