Healthcare Provider Details

I. General information

NPI: 1932293362
Provider Name (Legal Business Name): SHANNON BURNETTE RN,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 MAINE ST
QUINCY IL
62305-5849
US

IV. Provider business mailing address

1516 KENTUCKY ST
QUINCY IL
62301-4257
US

V. Phone/Fax

Practice location:
  • Phone: 217-223-0423
  • Fax: 217-223-0461
Mailing address:
  • Phone: 217-223-0423
  • Fax: 217-223-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberT184569
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2005010932
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041305868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: