Provider Demographics
NPI:1174844278
Name:WALTON, SHANNON MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:WALTON
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 1:5726 ALKIRE RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8894
Mailing Address - Country:US
Mailing Address - Phone:614-376-9374
Mailing Address - Fax:
Practice Address - Street 1:5726 ALKIRE RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8894
Practice Address - Country:US
Practice Address - Phone:614-376-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117725164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse