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General NPI Number Information
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NPI Number | 1609307750
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Entity Type | Individual
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Provider Name | SHANNON KAWA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE # 10
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-3404
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Fax | 312-227-9820
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Provider Business Mailing Address
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Address Line | 225 E CHICAGO AVE # 10
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 708-516-2307
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Fax | 312-227-9820
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.023176
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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 | 041.314114
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License Number State | IL
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