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Individual

DR. SUZAN CATHLEEN SHANE-GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APN, EDD

Contact information

Practice address
530 NE GLEN OAK AVE, POB 113, PEORIA, IL 61637-0001
(309) 224-8683
Mailing address
530 NE GLEN OAK AVE, POB 113, PEORIA, IL 61637-0001
(309) 224-8683

Taxonomy

Speciality
Code
Description
License number
State
364SP0200X
Pediatric Clinical Nurse Specialist
Primary
209.008562
IL

Other

Enumeration date
01/18/2011
Last updated
01/18/2011
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