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NPI Code Detail

MEDICARE: KRISTIN WARNER SHANNON DNP

MEDICARE: KRISTIN WARNER SHANNON DNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.013832IL
2363LC0200XCritical Care Medicine Nurse Practitioner209.013832IL

General Provider Information

NPI Number : 1013364926
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN WARNER SHANNON DNP
Provider Business Mailing Address
First Line : 2740 W FOSTER AVE
Second Line : STE 310
City : CHICAGO
State : IL
Zip : 60625-3500
Country : US
Telephone Number : 773-878-8200
Fax Number : 773-293-4197
Provider Business Practice Location Address
First Line : 6141 N CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60646-4303
Country : US
Telephone Number : 773-293-8788
Fax Number : 773-293-8791
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2016
Last Update Date : 10/30/2020

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