Individual
SHANNON SWANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
158 W MAIN RD, CONNEAUT, OH 44030-2039
(330) 493-4443
(330) 493-8677
Mailing address
4535 DRESSLER RD NW, CANTON, OH 44718-2545
(330) 493-4443
(330) 493-8677
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34008887
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383091
ANTHEM
OH
01
—
000000385522
ANTHEM
OH
01
—
101986736-0001
PENNSYLVANIA MEDICAID
OH
05
—
2708994
—
OH
Enumeration date
05/10/2006
Last updated
06/30/2023
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