Provider Demographics
NPI:1710451380
Name:SHIRES, ANGELA L (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:SHIRES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2599
Mailing Address - Country:US
Mailing Address - Phone:618-253-7637
Mailing Address - Fax:
Practice Address - Street 1:333 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2599
Practice Address - Country:US
Practice Address - Phone:618-253-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041308881163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool