Most Relevant Information
Provider Data
| NPI Number: | 1003572470 |
| Provider Name: | SHANNON LYNN WHITLEY APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209.023633 |
Most Important Dates
| Enumeration Date: | 11/10/2021 |
| Last Updated: | 11/10/2021 |
Provider Practice Location
1650 MIDTOWN RD
PERU
IL
613541200
Practice Location Phone/Fax
| Phone: | 8152236843 |
| Fax: |
Provider Mailing Location
1322 W MADISON ST
OTTAWA
IL
613502565
Provider Mailing Phone/Fax
| Phone: | 8158221077 |
| Fax: |