Provider Demographics
NPI:1700378650
Name:RAPP, SHANNON RAE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:RAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 WILLOW SPRINGS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4784
Mailing Address - Country:US
Mailing Address - Phone:708-482-7424
Mailing Address - Fax:708-482-7424
Practice Address - Street 1:7041 WILLOW SPRINGS RD STE 101
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4784
Practice Address - Country:US
Practice Address - Phone:708-482-7424
Practice Address - Fax:708-482-7424
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
IL3000854253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)