Individual
TRACY SHADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7220 GREAT HILL RD, CRYSTAL LAKE, IL 60012-1637
(847) 999-8777
(815) 893-4534
Mailing address
4215 NEWBURG RD, ROCKFORD, IL 61108-6479
(815) 988-8500
(815) 977-5956
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
277.001865
IL
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
277.001865
IL
Other
Enumeration date
04/24/2018
Last updated
12/12/2024
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