MEDICARE: MRS. SHEMS AL-TAIE FNP-C

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
1	163W00000X	Registered Nurse	041472081	IL
2	363LF0000X	Family Nurse Practitioner	209024059	IL

General Provider Information

NPI Number	:	1770127029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEMS AL-TAIE FNP-C

Provider Business Mailing Address
First Line	:	5461 W LAKE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644
Country	:	US
Telephone Number	:	312-866-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	5461 WEST LAKE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644
Country	:	US
Telephone Number	:	312-866-7058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	05/21/2025

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