Healthcare Provider Details

I. General information

NPI: 1831120054
Provider Name (Legal Business Name): KATHERINE KERRIGAN SHANNON RN, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 69 LURIE CHILDREN'S HOSPITAL OF CHICAGO
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

513 50TH PL
WESTERN SPRINGS IL
60558-1922
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6190
  • Fax: 312-227-9404
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209001239
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: