Provider Demographics
NPI:1164452496
Name:SHIMP, DENNIS (CRNA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SHIMP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DR WARREN TUTTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946
Mailing Address - Country:US
Mailing Address - Phone:618-253-7671
Mailing Address - Fax:618-253-7104
Practice Address - Street 1:100 DR WARREN TUTTLE DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946
Practice Address - Country:US
Practice Address - Phone:618-253-7671
Practice Address - Fax:618-253-7104
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered