Provider Demographics
NPI:1417332354
Name:RAPHAEL, SHAWNA (APRN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:630-655-6748
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:1440 W REPUBLIC RD STE 124
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5754
Practice Address - Country:US
Practice Address - Phone:877-448-3627
Practice Address - Fax:866-507-1164
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015024624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily