Provider Demographics
NPI:1538930508
Name:SHUNK, MARIA ROSARIO (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSARIO
Last Name:SHUNK
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:R
Other - Last Name:SHUNK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:6705 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-7183
Mailing Address - Country:US
Mailing Address - Phone:773-456-7065
Mailing Address - Fax:
Practice Address - Street 1:6705 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-7183
Practice Address - Country:US
Practice Address - Phone:773-456-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027780363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner