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General NPI Number Information
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NPI Number | 1659882736
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Entity Type | Individual
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Provider Name | SHANNON ROSE LEWIS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 3314 S CICERO AVE
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City | CICERO
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State | IL
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Zip | 60804-4531
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Country | US
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Telephone | 708-391-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 AUBURN LN
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City | FRANKFORT
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State | IL
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Zip | 60423-1717
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Country | US
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Telephone | 312-437-0472
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209016553
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277002213
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License Number State | IL
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