Healthcare Provider Details

I. General information

NPI: 1427870351
Provider Name (Legal Business Name): SHELLEE MARIE HUFFSTUTLER CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34061 S RIVALS RD
WILMINGTON IL
60481-9790
US

IV. Provider business mailing address

34061 S RIVALS RD
WILMINGTON IL
60481-9790
US

V. Phone/Fax

Practice location:
  • Phone: 217-495-3025
  • Fax:
Mailing address:
  • Phone: 217-495-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: