Provider Demographics
NPI:1740435106
Name:WASHINGTON, SHANNON NICOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICOLE
Last Name:WASHINGTON
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 1:10685 CHELMSFORD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3909
Mailing Address - Country:US
Mailing Address - Phone:513-742-2354
Mailing Address - Fax:
Practice Address - Street 1:10685 CHELMSFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3909
Practice Address - Country:US
Practice Address - Phone:513-742-2354
Practice Address - Fax:513-742-0977
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN119585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse