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SARAH ELIZABETH RUTH SHANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
2601 W MAIN ST, CARBONDALE, IL 62901
(618) 549-5361
(618) 351-4878
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
(618) 529-0586

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209016484
IL
363LF0000X
Family Nurse Practitioner
CP001152
SD

Other

Enumeration date
11/28/2016
Last updated
11/13/2019
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