Provider Demographics
NPI:1235353632
Name:CAUDILL, SHANNON LYNN I (RN318943)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LYNN
Last Name:CAUDILL
Suffix:I
Gender:F
Credentials:RN318943
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 HALL ROAD
Mailing Address - Street 2:
Mailing Address - City:SCIOTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-285-7311
Mailing Address - Fax:
Practice Address - Street 1:149 HALL RD
Practice Address - Street 2:
Practice Address - City:SCIOTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45662-9044
Practice Address - Country:US
Practice Address - Phone:740-285-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.318943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse