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General NPI Number Information
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NPI Number | 1932593910
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Entity Type | Individual
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Provider Name | SHONTEL MARLENA RAY AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 7234 W NORTH AVE STE 208
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-4202
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Country | US
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Telephone | 618-746-0052
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Fax | 618-300-7060
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Provider Business Mailing Address
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Address Line | 7234 W NORTH AVE STE 208
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-4202
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Country | US
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Telephone | 618-746-0052
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Fax | 618-300-7060
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2015001948
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209013100
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277002617
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License Number State | IL
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