Provider Demographics
NPI:1730963596
Name:NANAETO, SHANNON CHERIE (MS, APRN-CNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHERIE
Last Name:NANAETO
Suffix:
Gender:F
Credentials:MS, APRN-CNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:318 TRIBUTE TRL
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-5000
Mailing Address - Country:US
Mailing Address - Phone:918-260-7631
Mailing Address - Fax:
Practice Address - Street 1:1755 N HIGHWAY 66 STE G
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2717
Practice Address - Country:US
Practice Address - Phone:918-260-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK211952363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care