Provider Demographics
NPI:1225883812
Name:REIGRUT, SHANNON
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:REIGRUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1632
Mailing Address - Country:US
Mailing Address - Phone:330-787-1897
Mailing Address - Fax:
Practice Address - Street 1:353 OAK ST
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1632
Practice Address - Country:US
Practice Address - Phone:330-787-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide