Provider Demographics
NPI:1437889953
Name:HILEMAN, SHAWNNA MAIRE
Entity Type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:MAIRE
Last Name:HILEMAN
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 1:727 VOGEL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4575
Mailing Address - Country:US
Mailing Address - Phone:234-207-7805
Mailing Address - Fax:
Practice Address - Street 1:727 VOGEL AVE NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4575
Practice Address - Country:US
Practice Address - Phone:234-207-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization