Individual
TIFFANY SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14708 KENTON AVE, MIDLOTHIAN, IL 60445-3222
(708) 631-6985
Mailing address
14708 KENTON AVE, MIDLOTHIAN, IL 60445-3222
(708) 631-6985
(708) 631-6985
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
041563450
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011639293
FOID CARD
IL
01
—
ORX134
BCBS
IL
Enumeration date
05/23/2025
Last updated
05/23/2025
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