Healthcare Provider Details

I. General information

NPI: 1306320031
Provider Name (Legal Business Name): SHANNON KEISER DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 COMPASS RD STE 125
GLENVIEW IL
60026-8089
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-3376
  • Fax:
Mailing address:
  • Phone: 206-639-0089
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017935
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: