Provider Demographics
NPI:1942803002
Name:OCHOA, SHANNON LYN (DNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYN
Last Name:OCHOA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MACKINAW RD STE 4200
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9533
Mailing Address - Country:US
Mailing Address - Phone:989-791-2330
Mailing Address - Fax:989-791-2329
Practice Address - Street 1:5400 MACKINAW RD STE 4200
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9533
Practice Address - Country:US
Practice Address - Phone:989-791-2330
Practice Address - Fax:989-791-2329
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237490163WX0200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology