Provider Demographics
NPI:1891042362
Name:MERRIMAN, SHANNON LYN (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYN
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 US ROUTE 68 S
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9751
Mailing Address - Country:US
Mailing Address - Phone:614-439-1690
Mailing Address - Fax:
Practice Address - Street 1:1650 US ROUTE 68 S
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9751
Practice Address - Country:US
Practice Address - Phone:614-439-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH288604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse