Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209.010823 | IL |
N | 363LA2100X | Nurse Practitioner - Acute Care | 209010823 | IL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 209010823 | IL |
NPI | 1063840619 |
---|---|
Provider Name | Taryn T Shelby |
First Address | Palos Heights, IL 60463-1256 |
Second Address | Palos Heights, IL 60463-1256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2013 |
Last Update Date | 17/09/2020 |