Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209.013832 | IL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209.013832 | IL |
NPI | 1013364926 |
---|---|
Provider Name | Kristin Warner Shannon |
First Address | Chicago, IL 60625-3500 |
Second Address | Chicago, IL 60646-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2016 |
Last Update Date | 30/10/2020 |