Provider Demographics
NPI:1558198739
Name:KEITH, SHANNON (ARNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 75TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7926
Mailing Address - Country:US
Mailing Address - Phone:630-375-1625
Mailing Address - Fax:630-429-9870
Practice Address - Street 1:3965 75TH ST STE 103
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7926
Practice Address - Country:US
Practice Address - Phone:630-375-1625
Practice Address - Fax:630-429-9870
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily