Individual
JENNY MAY SHOOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(309) 323-3072
Mailing address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
209.016277
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.016277
209.016277
IL
Enumeration date
08/09/2017
Last updated
08/09/2017
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