MEDICARE: MR. ROBERT JAMES SHAUGHNESSY CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist		IL

General Provider Information

NPI Number	:	1477754224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JAMES SHAUGHNESSY CRNA

Provider Business Mailing Address
First Line	:	11050 84TH PL
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1102
Country	:	US
Telephone Number	:	708-839-8173
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-1746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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