Healthcare Provider Details

I. General information

NPI: 1841050705
Provider Name (Legal Business Name): JANINA SHORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 BROOKFIELD DR
PLAINFIELD IL
60586-7575
US

IV. Provider business mailing address

1510 BROOKFIELD DR
PLAINFIELD IL
60586-7575
US

V. Phone/Fax

Practice location:
  • Phone: 630-674-3501
  • Fax:
Mailing address:
  • Phone: 630-674-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number812990
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: