Provider Demographics
NPI:1679838254
Name:MEDER, CHRISTINA SHANNON (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SHANNON
Last Name:MEDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 ROYAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6030
Mailing Address - Country:US
Mailing Address - Phone:440-667-7570
Mailing Address - Fax:
Practice Address - Street 1:8515 ROYAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6030
Practice Address - Country:US
Practice Address - Phone:440-667-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2768670Medicaid
OH140403OtherLPN