Provider Demographics
NPI:1972262632
Name:KIESWETTER, SHANA (RN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:KIESWETTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:CREADON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1508 W RIVER RD N
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2714
Practice Address - Country:US
Practice Address - Phone:440-647-8100
Practice Address - Fax:440-426-8375
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.179620.MEDS-IV164W00000X
OHRN.542140163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse