Provider Demographics
NPI:1356378319
Name:MORROW, SHANNON L (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:MORROW
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6440 MAIN STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-633-1229
Mailing Address - Fax:708-482-3230
Practice Address - Street 1:6440 MAIN STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:630-633-1229
Practice Address - Fax:708-482-3230
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL385-000897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP80343Medicare UPIN