Provider Demographics
NPI:1306185103
Name:CHEN, SHAN (APRN)
Entity Type:Individual
Prefix:
First Name:SHAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ASHBURY DR
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4992
Mailing Address - Country:US
Mailing Address - Phone:630-706-1569
Mailing Address - Fax:
Practice Address - Street 1:333 MADISON ST STE 150
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8200
Practice Address - Country:US
Practice Address - Phone:877-692-8686
Practice Address - Fax:815-729-4201
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010112OtherSTATE LICENSE FOR ADVANCED PRACTICE NURSE