Provider Demographics
NPI:1265967293
Name:NIXON, SHANNON OLIVIA (LPN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:OLIVIA
Last Name:NIXON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MARTIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARPURSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13787-1623
Mailing Address - Country:US
Mailing Address - Phone:607-349-8895
Mailing Address - Fax:
Practice Address - Street 1:48 MARTIN HILL RD
Practice Address - Street 2:
Practice Address - City:HARPURSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13787-1623
Practice Address - Country:US
Practice Address - Phone:607-349-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse