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General NPI Number Information
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NPI Number | 1043845084
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Entity Type | Individual
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Provider Name | SHANELL RENA GLADSON APRN
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Gender | Female
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 11/16/2025
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Provider Practice Location Address
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Address Line | 4615 CORREL AVE
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City | BARTONVILLE
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State | IL
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Zip | 61607-2618
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Country | US
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Telephone | 309-453-0688
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Fax | 309-324-5977
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Provider Business Mailing Address
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Address Line | 4615 CORREL AVE
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City | BARTONVILLE
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State | IL
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Zip | 61607-2618
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Country | US
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Telephone | 309-453-0688
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Fax | 309-324-5977
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 209031579
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN233341
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 04105255
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 23341
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License Number State | AZ
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