Healthcare Provider Details

I. General information

NPI: 1811322027
Provider Name (Legal Business Name): SHANNON HOUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON TAIT

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 KINGERY HWY
WILLOWBROOK IL
60527-5538
US

IV. Provider business mailing address

7601 KINGERY HWY
WILLOWBROOK IL
60527-5538
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10052937
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010332
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14252956-4405
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-280203
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86865
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN5647-0
License Number StateHI
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025049738
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70066860
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: