Provider Demographics
NPI:1730663238
Name:STIREMAN, SHANNON SHEA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:SHEA
Last Name:STIREMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:SHEA
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8638 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1051
Mailing Address - Country:US
Mailing Address - Phone:937-237-9575
Mailing Address - Fax:
Practice Address - Street 1:8638 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1051
Practice Address - Country:US
Practice Address - Phone:937-237-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH023059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily