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General NPI Number Information
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NPI Number | 1316304637
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Entity Type | Individual
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Provider Name | SHENELL THOMAS FNP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2016
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 4001 VOLLMER RD
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-3168
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Country | US
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Telephone | 708-481-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209013745
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License Number State | IL
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