Provider Demographics
NPI:1083398754
Name:HOCKENBERRY, SHANNA CRYSTAL
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:CRYSTAL
Last Name:HOCKENBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7350
Mailing Address - Country:US
Mailing Address - Phone:567-303-4139
Mailing Address - Fax:
Practice Address - Street 1:1722 ROCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7350
Practice Address - Country:US
Practice Address - Phone:567-303-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker