Provider Demographics
NPI:1982987079
Name:HILL, SHAUN M (LPN)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:M
Last Name:HILL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 SHUMAKER DR.
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811
Mailing Address - Country:US
Mailing Address - Phone:419-217-1766
Mailing Address - Fax:
Practice Address - Street 1:639 SHUMAKER DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1639
Practice Address - Country:US
Practice Address - Phone:419-217-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.143132-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse