Individual
SHELBY MATILLANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN-CRNA
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 982-3172
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 982-3172
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.419888
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209030919
IL
Other
Enumeration date
07/09/2024
Last updated
10/30/2024
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