Provider Demographics
NPI:1437869435
Name:SHEETER, CONNIE LYNN
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:SHEETER
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 1:5080 MONO DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9537
Mailing Address - Country:US
Mailing Address - Phone:330-317-6087
Mailing Address - Fax:
Practice Address - Street 1:5080 MONO DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9537
Practice Address - Country:US
Practice Address - Phone:330-317-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN-126065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse