Provider Demographics
NPI:1629288816
Name:SHULE, LAREE A (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAREE
Middle Name:A
Last Name:SHULE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 E WALNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1806
Mailing Address - Country:US
Mailing Address - Phone:815-432-7693
Mailing Address - Fax:815-936-7228
Practice Address - Street 1:1490 E WALNUT ST
Practice Address - Street 2:STE A
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1806
Practice Address - Country:US
Practice Address - Phone:815-432-7693
Practice Address - Fax:815-936-7228
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002831364SC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine