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Organization
SRS MEN'S VITALITY HUB
Active
Organization
SRS MEN'S VITALITY HUB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON ROSE LEWIS FNP (PROVIDER, OWNER)
(312) 437-0472
Entity
Organization
Contact information
Practice address
7907 W 159TH ST UNIT C, TINLEY PARK, IL 60477-1345
(312) 872-8864
Mailing address
850 W BARTLETT RD STE 5C, BARTLETT, IL 60103-4454
(128) 728-8643
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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