Provider Demographics
NPI:1659882736
Name:LEWIS, SHANNON ROSE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ROSE
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:8225 AUBURN LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1717
Mailing Address - Country:US
Mailing Address - Phone:312-437-0472
Mailing Address - Fax:
Practice Address - Street 1:3314 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4531
Practice Address - Country:US
Practice Address - Phone:708-391-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016553363LF0000X
IL277002213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily