Healthcare Provider Details

I. General information

NPI: 1922283613
Provider Name (Legal Business Name): SHAWNA LYNN SULLIVAN APN/CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2008
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD SUITE 705B
ELK GROVE VILLAGE IL
60007-3361
US

IV. Provider business mailing address

2500 W HIGGINS RD SUITE 505
HOFFMAN ESTATES IL
60169-7220
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-0726
  • Fax: 847-843-2430
Mailing address:
  • Phone: 847-843-0806
  • Fax: 847-884-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.006872
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: