SRS Men's Vitality Hub

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

SRS MEN'S VITALITY HUB

Practice address

7907 W 159TH St Unit C
Tinley Park, IL 60477-1345

Phone

(312) 872-8864

NPI assigned

Feb 7, 2024

Last updated

Feb 7, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shannon Rose Lewis, FNPNPI 1659882736

Title

Provider, Owner

Phone

(312) 437-0472

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shannon Rose Lewis, FNP-BC

  • Family Nurse Practitioner
  • Naperville, IL
  • NPI 1659882736
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1194589432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W BARTLETT RD STE 5C",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601034454",
            "telephone_number": "128-728-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7907 W 159TH ST UNIT C",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771345",
            "telephone_number": "312-872-8864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 W Bartlett Rd Ste 5C",
            "address_purpose": "LOCATION",
            "city": "Bartlett",
            "state": "IL",
            "postal_code": "601034454",
            "country_code": "US",
            "telephone_number": "312-872-8864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SRS MEN'S VITALITY HUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "PROVIDER, OWNER",
        "authorized_official_telephone_number": "312-437-0472",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.