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Individual
SHANNON DANIELLE FRY
Active
Individual
SHANNON DANIELLE FRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
209.025648
IL
163WP0000X
Pain Management Registered Nurse
277003983
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
209.025648
IL
208100000X
Physical Medicine & Rehabilitation Physician
277003983
IL
363LF0000X
Family Nurse Practitioner
Primary
277003983
IL
363LF0000X
Family Nurse Practitioner
A169408
IA
Other
Enumeration date
06/20/2022
Last updated
07/31/2026
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