Provider Demographics
NPI:1588399240
Name:TODD, SHELLY LYNN (APRN,CNP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:TODD
Suffix:
Gender:F
Credentials:APRN,CNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:115 N ELIZABETH ST
Mailing Address - Street 2:STRONGHURST IL 61480
Mailing Address - City:STRONGHURST
Mailing Address - State:IL
Mailing Address - Zip Code:61480
Mailing Address - Country:US
Mailing Address - Phone:121-357-7777
Mailing Address - Fax:
Practice Address - Street 1:115 N ELIZABETH ST
Practice Address - Street 2:STRONGHURST IL 61480
Practice Address - City:STRONGHURST
Practice Address - State:IL
Practice Address - Zip Code:61480
Practice Address - Country:US
Practice Address - Phone:121-735-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025413207Q00000X
IL209025413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine