Healthcare Provider Details

I. General information

NPI: 1629288816
Provider Name (Legal Business Name): LAREE A SHULE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E WALNUT ST STE A
WATSEKA IL
60970-1806
US

IV. Provider business mailing address

1490 E WALNUT ST STE A
WATSEKA IL
60970-1806
US

V. Phone/Fax

Practice location:
  • Phone: 815-432-7693
  • Fax: 815-936-7228
Mailing address:
  • Phone: 815-432-7693
  • Fax: 815-936-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number209-002831
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-002831
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: