Healthcare Provider Details

I. General information

NPI: 1972433738
Provider Name (Legal Business Name): SHANNON MYLEE HASTINGS DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19710 GOVERNORS HWY STE 5
FLOSSMOOR IL
60422-2081
US

IV. Provider business mailing address

19710 GOVERNORS HWY STE 5
FLOSSMOOR IL
60422-2081
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-2147
  • Fax:
Mailing address:
  • Phone: 773-569-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: