Individual
KELLY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2501
(217) 902-3140
Mailing address
1096 BUCKS POND RD, MONTICELLO, IL 61856-8058
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
041447434
IL
Other
Enumeration date
09/20/2025
Last updated
09/20/2025
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