Healthcare Provider Details

I. General information

NPI: 1386215309
Provider Name (Legal Business Name): SHIRLEY SCOTT WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST # MC718
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST # MC718
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 224-650-7123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.023734
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041283655
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041283655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: