Provider Demographics
NPI:1326059593
Name:SHEA, KAREN (CNS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S MEYERS RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5243
Mailing Address - Country:US
Mailing Address - Phone:630-873-7305
Mailing Address - Fax:630-416-3189
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:DOB 3 SUITE 3200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-882-8448
Practice Address - Fax:847-882-8481
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004606364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK02105Medicare ID - Type UnspecifiedLOCAL 15
P17931Medicare UPIN