Individual provider · Type 1 NPI

Shanna Marie Widera, RN, APN

Pediatric Nurse Practitioner · Chicago, IL

NPI number 1790710531 Active

Practice location

225 E Chicago Ave, Box #59
Chicago, IL 60611-2991

Call (312) 227-6778 Map

Fax (312) 227-9413

Mailing address

1221 N Dearborn St Apt 603N
Chicago, IL 60610-8375

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200X209004579 (IL)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1790710531

Shanna Marie Widera, RN, APN's National Provider Identifier is 1790710531, issued on Jul 11, 2006. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Chicago, IL. The record was last updated on Nov 21, 2019.