Individual
TERRI NANNETTE SHUMWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
8600 N. ROUTE 91, PEORIA, IL 61615-1111
(309) 683-5050
(309) 683-5335
Mailing address
8600 N. ROUTE 91, PEORIA, IL 61615-0001
(309) 683-5050
(309) 683-5335
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-004693
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005832068
BCBS GROUP ID
IL
01
—
1528084266
GROUP NPI
IL
01
—
1972612836
NPI
IL
01
—
213056
MEDICARE GROUP
IL
01
—
DE5770
RR GROUP #
IL
01
—
P00332136
RR MEDICARE INDIVIDUAL PI
IL
01
—
TAX ID
30-0024900
IL
Enumeration date
08/30/2006
Last updated
06/06/2013
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