Provider Demographics
NPI:1548613094
Name:REPA, SHAUNNA R (APN)
Entity type:Individual
Prefix:
First Name:SHAUNNA
Middle Name:R
Last Name:REPA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3935
Mailing Address - Country:US
Mailing Address - Phone:630-830-5926
Mailing Address - Fax:
Practice Address - Street 1:6620 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3935
Practice Address - Country:US
Practice Address - Phone:630-830-5926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily