Provider Demographics
NPI:1073940649
Name:LITTEKEN, SHANNA M (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:M
Last Name:LITTEKEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:M
Other - Last Name:STRIEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1094 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1364
Mailing Address - Country:US
Mailing Address - Phone:618-304-5356
Mailing Address - Fax:
Practice Address - Street 1:333 S KIRKWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6161
Practice Address - Country:US
Practice Address - Phone:314-909-1666
Practice Address - Fax:314-909-7406
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant