Healthcare Provider Details

I. General information

NPI: 1073491833
Provider Name (Legal Business Name): CORINNE LADAN SHAW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SILVER CROSS BLVD STE 370
NEW LENOX IL
60451-9607
US

IV. Provider business mailing address

1890 SILVER CROSS BLVD STE 370
NEW LENOX IL
60451-9607
US

V. Phone/Fax

Practice location:
  • Phone: 815-717-8727
  • Fax:
Mailing address:
  • Phone: 815-717-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.036252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: