Provider Demographics
NPI:1972190767
Name:HARAMIJA, SHAUNA MARIE
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:HARAMIJA
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 1:12624 W OAK VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9064
Mailing Address - Country:US
Mailing Address - Phone:708-717-3606
Mailing Address - Fax:
Practice Address - Street 1:301 SPRINGFIELD AVE STE 2
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8202
Practice Address - Country:US
Practice Address - Phone:815-630-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.408926163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse