Provider Demographics
NPI:1861975716
Name:SHANLEY, LAUREL (CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:SHANLEY
Suffix:
Gender:F
Credentials:CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2975
Mailing Address - Country:US
Mailing Address - Phone:216-587-8335
Mailing Address - Fax:216-587-5860
Practice Address - Street 1:12300 MCCRACKEN ROAD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2914
Practice Address - Country:US
Practice Address - Phone:216-587-8335
Practice Address - Fax:216-587-8646
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.443955163W00000X
OHAPRN.CNP.024475363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse