Provider Demographics
NPI:1669060091
Name:FERN, SHELLY (APRN, CNP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:FERN
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:SANTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:5 KISH HOSPITAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9602
Mailing Address - Country:US
Mailing Address - Phone:815-748-6071
Mailing Address - Fax:630-938-2679
Practice Address - Street 1:5 KISH HOSPITAL DR STE 203
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:815-748-6071
Practice Address - Fax:630-938-2679
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022615363L00000X
IL209.022615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner