Provider Demographics
NPI:1689903353
Name:MCNARY, SHANNON NICHOLE (LPN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICHOLE
Last Name:MCNARY
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 1:1724 KINGS MILL CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3503
Mailing Address - Country:US
Mailing Address - Phone:937-838-2288
Mailing Address - Fax:
Practice Address - Street 1:1724 KINGS MILL CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3503
Practice Address - Country:US
Practice Address - Phone:937-838-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN15067164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse