Provider Demographics
NPI:1841594033
Name:DAVIS, SHAWNNA NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNNA
Middle Name:NICOLE
Last Name:DAVIS
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 1:3480 TOWNSHIP ROAD 159
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9311
Mailing Address - Country:US
Mailing Address - Phone:740-390-1101
Mailing Address - Fax:
Practice Address - Street 1:3480 TOWNSHIP ROAD 159
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9311
Practice Address - Country:US
Practice Address - Phone:740-390-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 142353-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse