Provider Demographics
NPI:1063027746
Name:FRISBY, SHANNON (LPN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FRISBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 GLADE RUN RD
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-9767
Mailing Address - Country:US
Mailing Address - Phone:740-710-0910
Mailing Address - Fax:
Practice Address - Street 1:1574 GLADE RUN RD
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-9767
Practice Address - Country:US
Practice Address - Phone:740-710-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168083164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse