Provider Demographics
NPI:1831120054
Name:SHANNON, KATHERINE KERRIGAN (RN, MS)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:KERRIGAN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:RN, MS
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Mailing Address - Street 1:513 50TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE # 69
Practice Address - Street 2:LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6190
Practice Address - Fax:312-227-9404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209001239363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics