Provider Demographics
NPI:1619581303
Name:SHAW, SHAWNALEE ROCHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAWNALEE
Middle Name:ROCHELLE
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7653 MENDOCINO DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5123
Mailing Address - Country:US
Mailing Address - Phone:847-924-8930
Mailing Address - Fax:
Practice Address - Street 1:7653 MENDOCINO DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5123
Practice Address - Country:US
Practice Address - Phone:847-924-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily