MEDICARE: KATHERINE SHIPLEY DNP, FNP-BC

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	363L00000X	Nurse Practitioner	209023812	IL
2	363LF0000X	Family Nurse Practitioner	209023812	IL

General Provider Information

NPI Number	:	1760143259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SHIPLEY DNP, FNP-BC

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-2160
Fax Number	:	847-570-5097

Provider Business Practice Location Address
First Line	:	2333 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3838
Country	:	US
Telephone Number	:	773-231-9884
Fax Number	:

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

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/22/2024

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