Provider Demographics
NPI:1215602628
Name:MURPHY, SHANNON DOUGLAS (AGACNP)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:DOUGLAS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
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Mailing Address - Street 1:6639 AMSTERDAM DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 EATON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2767
Practice Address - Country:US
Practice Address - Phone:513-867-2819
Practice Address - Fax:513-867-2558
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029482363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care