Provider Demographics
NPI:1053757971
Name:GREAKER, SHANNON MARIE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:GREAKER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:GRAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-366-6675
Mailing Address - Fax:614-293-4030
Practice Address - Street 1:2050 KENNY RD STE 2500
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-366-6675
Practice Address - Fax:614-366-8166
Is Sole Proprietor?:No
Enumeration Date:2013-05-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.14768363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099664Medicaid