Individual provider · Type 1 NPI
Tracy Shadley, FNP
Psychiatric/Mental Health Clinical Nurse Specialist · Crystal Lake, IL
NPI number
1699263731
Active
Practice location
7220 Great Hill Rd
Crystal Lake, IL 60012-1637
Fax (815) 893-4534
Mailing address
4215 Newburg Rd
Rockford, IL 61108-6479
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 277.001865 (IL) |
| Psychiatric/Mental Health Clinical Nurse Specialist Primary | 364SP0808X | 277.001865 (IL) |
Psychiatric/Mental Health Clinical Nurse Specialist: Definition to come...
About NPI 1699263731
Tracy Shadley, FNP's National Provider Identifier is 1699263731, issued on Apr 24, 2018. The primary taxonomy on file is Psychiatric/Mental Health Clinical Nurse Specialist (364SP0808X), and the practice location is in Crystal Lake, IL. The record was last updated on Dec 12, 2024.