Provider Demographics
NPI:1336480490
Name:KRAUSE, SHANNA S (ANP-FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:S
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:ANP-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY CIR
Mailing Address - Street 2:WESTERN ILLINOIS UNIVERSITY
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-1367
Mailing Address - Country:US
Mailing Address - Phone:309-298-1888
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY CIRCLE
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3313
Practice Address - Country:US
Practice Address - Phone:309-298-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily