Provider Demographics
NPI:1033308820
Name:QUICK, SHONA JO (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHONA
Middle Name:JO
Last Name:QUICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SHONA
Other - Middle Name:JO
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:20733 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-3710
Mailing Address - Country:US
Mailing Address - Phone:217-854-3141
Mailing Address - Fax:
Practice Address - Street 1:20733 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-3710
Practice Address - Country:US
Practice Address - Phone:217-854-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005202363LF0000X
MO140976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL384230010Medicare PIN