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NPI Code Detail

MEDICARE: SHAUNA SUE STARK DNP

MEDICARE: SHAUNA SUE STARK DNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner209-035661IL

General Provider Information

NPI Number : 1609303676
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUNA SUE STARK DNP
Provider Business Mailing Address
First Line : 1620 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3801
Country : US
Telephone Number : 312-947-1000
Fax Number :
Provider Business Practice Location Address
First Line : 1620 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3801
Country : US
Telephone Number : 312-947-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2017
Last Update Date : 05/21/2026

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