Provider Demographics
NPI:1093249153
Name:BRENT, SHANNON (CNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BRENT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2910
Mailing Address - Country:US
Mailing Address - Phone:216-318-9305
Mailing Address - Fax:
Practice Address - Street 1:1001 LAKESIDE AVE E STE 1000
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1162
Practice Address - Country:US
Practice Address - Phone:216-318-9305
Practice Address - Fax:855-543-4914
Is Sole Proprietor?:No
Enumeration Date:2017-04-16
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.340899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily