Provider Demographics
NPI:1144452939
Name:SHEBAR, ILA KAREN (NP)
Entity type:Individual
Prefix:MS
First Name:ILA
Middle Name:KAREN
Last Name:SHEBAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASON AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1119
Mailing Address - Country:US
Mailing Address - Phone:413-241-2100
Mailing Address - Fax:413-735-1986
Practice Address - Street 1:100 WASON AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1119
Practice Address - Country:US
Practice Address - Phone:413-241-2100
Practice Address - Fax:413-735-1986
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN156477363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health