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General NPI Number Information
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NPI Number | 1699633255
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Entity Type | Individual
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Provider Name | MRS. KASSANDRA NICOLE SHANNON
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Gender | Female
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 22285 N PEPPER RD STE 310
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City | LAKE BARRINGTON
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State | IL
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Zip | 60010-2541
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Country | US
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Telephone | 847-382-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 E HALMA LANE
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City | WOODSTOCK
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State | IL
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Zip | 60098
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Country | US
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Telephone |
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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 | 209.034375
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License Number State | IL
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