Provider Demographics
NPI:1700650231
Name:MEADOWS, SHELBY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:LYNN
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1771 N STATE ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60928-7026
Mailing Address - Country:US
Mailing Address - Phone:815-922-9793
Mailing Address - Fax:
Practice Address - Street 1:285 N SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3830
Practice Address - Country:US
Practice Address - Phone:815-939-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041492042163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health