Provider Demographics
NPI:1316354608
Name:BAXTER, SHANNON (CNM, FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-1260
Mailing Address - Country:US
Mailing Address - Phone:574-265-8382
Mailing Address - Fax:574-971-4264
Practice Address - Street 1:415 W UNION ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-1260
Practice Address - Country:US
Practice Address - Phone:574-265-8382
Practice Address - Fax:574-971-4264
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000246A363LP2300X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care