Provider Demographics
NPI:1972612836
Name:SHUMWAY, TERRI NANNETTE (APN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:NANNETTE
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:NANNETTE
Other - Last Name:BURGENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:8600 N. ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-0001
Mailing Address - Country:US
Mailing Address - Phone:309-683-5050
Mailing Address - Fax:309-683-5335
Practice Address - Street 1:8600 N. ROUTE 91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1111
Practice Address - Country:US
Practice Address - Phone:309-683-5050
Practice Address - Fax:309-683-5335
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDE5770OtherRR GROUP #
ILTAX IDOther30-0024900
IL1972612836OtherNPI
ILP00332136OtherRR MEDICARE INDIVIDUAL PI
IL0005832068OtherBCBS GROUP ID
IL1528084266OtherGROUP NPI
IL213056OtherMEDICARE GROUP
IL1528084266OtherGROUP NPI
ILK30302Medicare PIN