Provider Demographics
NPI:1699911842
Name:RUMACK, SHANDALLA L (FNP)
Entity type:Individual
Prefix:MS
First Name:SHANDALLA
Middle Name:L
Last Name:RUMACK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHANDALLA
Other - Middle Name:
Other - Last Name:RIGBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8307 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3129
Mailing Address - Country:US
Mailing Address - Phone:708-452-0920
Mailing Address - Fax:
Practice Address - Street 1:8307 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3129
Practice Address - Country:US
Practice Address - Phone:708-452-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001503171100000X
WAMA0022061225700000X
IL209.028935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist