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NPI Code Detail

MEDICARE: SHANNON DOUGLAS FNP

MEDICARE: SHANNON DOUGLAS FNP
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
1363LF0000XFamily Nurse PractitionerCOA.19029-NPOH

General Provider Information

NPI Number : 1679920466
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON DOUGLAS FNP
Provider Business Mailing Address
First Line : 543 PARK AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45013-3033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 543 PARK AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45013-3033
Country : US
Telephone Number : 513-737-0257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2016
Last Update Date : 05/21/2016

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