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1356973762
STACEY A SHAW
CHICAGO, IL
NPI
1356973762
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LP0200X Nurse Practitioner, Pediatrics
(Licence: IL 209019812)
Enumeration Date
2020-02-04
Last Update Date
2022-10-24
Business Address
STACEY A SHAW
5841 S MARYLAND AVE
CHICAGO, IL 60637-1443
Phone number: 888-824-0200
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Mailing Address
STACEY A SHAW
150 HARVESTER DR SUITE 300
BURR RIDGE, IL 60527-5919
Phone number:
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