Provider Demographics
NPI:1538640636
Name:STUDER, SHANNON LYNAE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNAE
Last Name:STUDER
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 1:1509 S CONWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9448
Mailing Address - Country:US
Mailing Address - Phone:419-964-5140
Mailing Address - Fax:
Practice Address - Street 1:437 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2609
Practice Address - Country:US
Practice Address - Phone:419-455-7790
Practice Address - Fax:419-443-0036
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily