Individual
MRS. KIMBERLY B SHELANSKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
200 RIVERSIDE DR, BOURBONNAIS, IL 60914-4689
(815) 933-9660
(815) 929-0014
Mailing address
200 RIVERSIDE DR, BOURBONNAIS, IL 60914-4689
(815) 933-9660
(815) 929-0014
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209008580
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4671139
—
MI
01
—
KO196003
BCBS PIN
MI
01
—
P01226063
RAILROAD MEDICARE
IL
Enumeration date
06/12/2006
Last updated
03/29/2021
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