Provider Demographics
NPI:1043898166
Name:SHAPPELL, REBECCA CLAIRE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIRE
Last Name:SHAPPELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 N KEYSTONE AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2447
Mailing Address - Country:US
Mailing Address - Phone:260-702-6085
Mailing Address - Fax:
Practice Address - Street 1:4142 N KEYSTONE AVE APT 7
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2447
Practice Address - Country:US
Practice Address - Phone:260-702-6085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program