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General NPI Number Information
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NPI Number | 1679161442
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Entity Type | Organization
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Legal Business Name | SHUNGO CARE
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 16 E US HIGHWAY 30
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2105
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Country | US
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Telephone | 219-515-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 273 MILBURN AVE
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City | CRETE
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State | IL
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Zip | 60417-2312
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Country | US
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Telephone | 219-202-2216
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS AYANNA D WASHINGTON
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Credential | ADVANCED PRACTICE RN
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Telephone | 219-515-6182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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