Healthcare Provider Details

I. General information

NPI: 1568327807
Provider Name (Legal Business Name): KELLEY LYNNE SHELLENBERGER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N SAINT CLAIR ST STE 5000
CHICAGO IL
60611-3234
US

IV. Provider business mailing address

633 N SAINT CLAIR ST STE 5000
CHICAGO IL
60611-3234
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7950
  • Fax: 312-926-4771
Mailing address:
  • Phone: 312-695-7950
  • Fax: 312-926-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209033901
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209033901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: