Provider Demographics
NPI:1346601077
Name:KOCH, SHANNONE (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:SHANNONE
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9405
Mailing Address - Country:US
Mailing Address - Phone:234-801-4747
Mailing Address - Fax:234-801-4647
Practice Address - Street 1:204 S BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9405
Practice Address - Country:US
Practice Address - Phone:234-801-4747
Practice Address - Fax:234-801-4647
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily