Individual
MRS. SHELLANE MARIE TANGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, MSN, FNP-BC
Contact information
Practice address
819 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 356-1558
Mailing address
2183 WAGON TRAIL RD, WHITE HEATH, IL 61884-9313
(217) 621-6874
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209015253
IL
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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