Provider Demographics
NPI:1831623636
Name:MOONAN, SHERI (CNS, APN)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:MOONAN
Suffix:
Gender:F
Credentials:CNS, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 W 95TH ST
Mailing Address - Street 2:6324P- LUNG TRANSPLANT OFFICE
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-9488
Mailing Address - Fax:708-684-3658
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:6324P- LUNG TRANSPLANT OFFICE
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-9488
Practice Address - Fax:708-684-3658
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007688364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine