Provider Demographics
NPI:1356973440
Name:SHEARER, DEBORAH JEAN
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:SHEARER
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 1:281 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3556
Mailing Address - Country:US
Mailing Address - Phone:309-297-9860
Mailing Address - Fax:
Practice Address - Street 1:281 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3556
Practice Address - Country:US
Practice Address - Phone:309-297-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041251570163WC0200X
IL209020674363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041251570OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL209020674OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION