Provider Demographics
NPI:1992939672
Name:NASH, SHANNON (ADN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 PINCKNEY RD
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9100
Mailing Address - Country:US
Mailing Address - Phone:734-330-6168
Mailing Address - Fax:
Practice Address - Street 1:7500 PINCKNEY RD
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-9100
Practice Address - Country:US
Practice Address - Phone:734-330-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233568163W00000X
IDN32498163W00000X
CA65599163W00000X
WV75320163W00000X
MA271379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse