Healthcare Provider Details

I. General information

NPI: 1831623636
Provider Name (Legal Business Name): SHERI MOONAN CNS, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST 6324P- LUNG TRANSPLANT OFFICE
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST 6324P- LUNG TRANSPLANT OFFICE
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-9488
  • Fax: 708-684-3658
Mailing address:
  • Phone: 708-684-9488
  • Fax: 708-684-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number209007688
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: