Provider Demographics
NPI:1770301376
Name:CHURCHILL, SHAUNTE NICHOLE-HILL (FNP)
Entity type:Individual
Prefix:
First Name:SHAUNTE
Middle Name:NICHOLE-HILL
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9077 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-3416
Mailing Address - Country:US
Mailing Address - Phone:614-928-4696
Mailing Address - Fax:
Practice Address - Street 1:9077 WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-3416
Practice Address - Country:US
Practice Address - Phone:614-928-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily