Provider Demographics
NPI:1902583438
Name:MILLIKEN, SHANNON MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-1098
Mailing Address - Country:US
Mailing Address - Phone:330-798-0491
Mailing Address - Fax:330-303-4948
Practice Address - Street 1:25 N CANFIELD NILES RD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2332
Practice Address - Country:US
Practice Address - Phone:307-980-4913
Practice Address - Fax:330-303-4948
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034239363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health