Provider Demographics
NPI:1376925586
Name:BENKO, SHANNON DIANN (NP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DIANN
Last Name:BENKO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DIANN
Other - Last Name:PYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2214 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3221
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-681-8443
Practice Address - Street 1:2251 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3825
Practice Address - Country:US
Practice Address - Phone:682-518-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-012715363LF0000X
TX1051781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1051781OtherCERTIFIED NURSE PRACTITIONER