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NPI Code Detail

MEDICARE: SHONTEL MARLENA RAY AGPCNP

MEDICARE: SHONTEL MARLENA RAY AGPCNP
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
1363LA2200XAdult Health Nurse Practitioner2015001948MO
2363LA2200XAdult Health Nurse Practitioner209013100IL
3363LP0808XPsychiatric/Mental Health Nurse Practitioner277002617IL

General Provider Information

NPI Number : 1932593910
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHONTEL MARLENA RAY AGPCNP
Provider Business Mailing Address
First Line : 7234 W NORTH AVE STE 208
Second Line :
City : ELMWOOD PARK
State : IL
Zip : 60707-4202
Country : US
Telephone Number : 618-746-0052
Fax Number : 618-300-7060
Provider Business Practice Location Address
First Line : 7234 W NORTH AVE STE 208
Second Line :
City : ELMWOOD PARK
State : IL
Zip : 60707-4202
Country : US
Telephone Number : 618-746-0052
Fax Number : 618-300-7060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2015
Last Update Date : 08/26/2025

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Directions to “ SHONTEL MARLENA RAY AGPCNP” Practice Location

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