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Individual

JACOB C SHIVELY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
11104 PARKVIEW CIRCLE DR STE 330, FORT WAYNE, IN 46845-1674
(260) 494-3484
(260) 969-0188
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71012742A
IN

Other

Enumeration date
04/28/2022
Last updated
11/01/2023
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