Provider Demographics
NPI:1124226865
Name:SHOMO, VAQUET A (CNP)
Entity Type:Individual
Prefix:
First Name:VAQUET
Middle Name:A
Last Name:SHOMO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VAQUET
Other - Middle Name:A
Other - Last Name:SHOMO-BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:7232 JUSTIN WAY
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4881
Mailing Address - Country:US
Mailing Address - Phone:440-578-8200
Mailing Address - Fax:330-626-1133
Practice Address - Street 1:7232 JUSTIN WAY
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4881
Practice Address - Country:US
Practice Address - Phone:440-578-8200
Practice Address - Fax:330-626-1133
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020411363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner