Individual
REGINA MARIE SHASHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
734 W 47TH ST, CHICAGO, IL 60609-4411
(773) 537-3161
Mailing address
4101 N RAVENSWOOD AVE, CHICAGO, IL 60613-2193
(773) 572-5224
(773) 537-3437
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
277000129
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
277000129
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209000848
LICENSE
IL
Enumeration date
02/28/2007
Last updated
03/15/2021
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