Provider Demographics
NPI:1396475687
Name:HARRIS KELLER, SHAMYRA (CNA)
Entity type:Individual
Prefix:
First Name:SHAMYRA
Middle Name:
Last Name:HARRIS KELLER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:SHAMYRA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:1625 S HARDING AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3973
Mailing Address - Country:US
Mailing Address - Phone:773-698-2414
Mailing Address - Fax:
Practice Address - Street 1:1625 S HARDING AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3973
Practice Address - Country:US
Practice Address - Phone:773-698-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide