Provider Demographics
NPI:1083826978
Name:VANHORN, SHANNON LEANN (STNA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEANN
Last Name:VANHORN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-5319
Mailing Address - Country:US
Mailing Address - Phone:740-454-2248
Mailing Address - Fax:740-454-2248
Practice Address - Street 1:1055 PINE ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-5319
Practice Address - Country:US
Practice Address - Phone:740-454-2248
Practice Address - Fax:740-454-2248
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide