Provider Demographics
NPI:1649534058
Name:POWERS, SHANNON N (MSN, CRNP, ACNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:POWERS
Suffix:
Gender:F
Credentials:MSN, CRNP, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WHITE POND DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1155
Mailing Address - Country:US
Mailing Address - Phone:330-926-3322
Mailing Address - Fax:330-926-3342
Practice Address - Street 1:701 WHITE POND DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1155
Practice Address - Country:US
Practice Address - Phone:330-926-3322
Practice Address - Fax:330-926-3342
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH290743163W00000X
OHCOA13463-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067591Medicaid