Provider Demographics
NPI:1861088742
Name:MOYER, SHAWNA (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BLUE QUAIL PL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-9833
Mailing Address - Country:US
Mailing Address - Phone:937-603-5640
Mailing Address - Fax:
Practice Address - Street 1:204 BLUE QUAIL PL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-9833
Practice Address - Country:US
Practice Address - Phone:937-603-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028381207Q00000X, 363LF0000X
OHLE-00034695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0