Provider Demographics
NPI:1871370486
Name:MIX, SHAWNE MICHAEL (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:SHAWNE
Middle Name:MICHAEL
Last Name:MIX
Suffix:
Gender:M
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 FICKEY DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2837
Mailing Address - Country:US
Mailing Address - Phone:440-749-8681
Mailing Address - Fax:
Practice Address - Street 1:3175 FICKEY DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2837
Practice Address - Country:US
Practice Address - Phone:440-749-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care