Provider Demographics
NPI:1003104449
Name:SPRADLIN, SHANNON RAE (LPN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RAE
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:346 CORKHILL CT
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61019-9519
Mailing Address - Country:US
Mailing Address - Phone:815-520-3789
Mailing Address - Fax:
Practice Address - Street 1:346 CORKHILL CT
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:IL
Practice Address - Zip Code:61019-9519
Practice Address - Country:US
Practice Address - Phone:815-520-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305838-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse