Provider Demographics
NPI:1427416999
Name:SHANESY, KATRINA RAE (CNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RAE
Last Name:SHANESY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:RAE
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 1013
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4466
Mailing Address - Fax:513-636-5846
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 1013
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4466
Practice Address - Fax:513-636-5846
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18931-NP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal