Healthcare Provider Details

I. General information

NPI: 1811521883
Provider Name (Legal Business Name): SHANA MARIE TESKE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA MARIE SIMPSON

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 N CONVENT ST STE 1
BOURBONNAIS IL
60914-1081
US

IV. Provider business mailing address

1615 N CONVENT ST STE 1
BOURBONNAIS IL
60914-1081
US

V. Phone/Fax

Practice location:
  • Phone: 815-602-8253
  • Fax: 815-937-2063
Mailing address:
  • Phone: 815-602-8253
  • Fax: 815-937-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020963
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: