Provider Demographics
NPI:1922283613
Name:SULLIVAN, SHAWNA LYNN (APN/CNP)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:LYNN
Last Name:SULLIVAN
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Gender:F
Credentials:APN/CNP
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Mailing Address - Street 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7220
Mailing Address - Country:US
Mailing Address - Phone:847-843-0806
Mailing Address - Fax:847-884-8340
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 705B
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-843-0726
Practice Address - Fax:847-843-2430
Is Sole Proprietor?:No
Enumeration Date:2008-01-01
Last Update Date:2024-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209.006872363LA2100X
IL209006872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400173737Medicare UPIN