Individual
KATELYN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10887 NEBRASKA ST, FRANKFORT, IL 60423-2290
(815) 666-7948
Mailing address
10887 NEBRASKA ST, FRANKFORT, IL 60423-2290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008663
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2021
Last updated
12/08/2021
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