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Stacey A Shaw

Nurse Practitioner, Pediatrics in Chicago, IL. Individual provider (NPI-1).

NPI number1356973762
StatusActive
Last updated in NPPESOct 24, 2022

Details

NPI
1356973762
Entity type
Individual (NPI-1)
Name
Stacey A Shaw
Sex
Female
Sole proprietor
No
Enumeration date
Feb 4, 2020
Certification date
Feb 4, 2020
Last updated
Oct 24, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics209019812ILYes

Practice location

5841 S Maryland Ave
Chicago, IL 60637-1443

Phone 888-824-0200

Mailing address

150 Harvester Dr
Suite 300
Burr Ridge, IL 60527-5919

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