Provider Demographics
NPI:1497647135
Name:NELSON, SHANNON MICHELLE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MICHELLE
Other - Last Name:MAXIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 16TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3610
Mailing Address - Country:US
Mailing Address - Phone:304-242-7751
Mailing Address - Fax:304-242-7254
Practice Address - Street 1:58 16TH ST STE 500
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3610
Practice Address - Country:US
Practice Address - Phone:304-242-7751
Practice Address - Fax:304-242-7254
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.356464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse