Shauntrese Porch, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041320318 Issued in IL

Practice address

9149 S Albany Ave
Evergreen Park, IL 60805-1718

Phone

(773) 320-7757

NPI assigned

Dec 9, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1275349862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 508",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604540508",
            "telephone_number": "773-320-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9149 S ALBANY AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608051718",
            "telephone_number": "773-320-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORCH",
        "first_name": "SHAUNTRESE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041320318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Philipsborn, M.D.
• Terese Marie Pikula, PTA
• Toya Pink
• Stanley Anthony Polit, MD
• Robert J. Pooley Jr., M.D.
• Michelle A Potempa
• Thomas Vincent Powell Jr., DDS
• Dora Alexandra Prah
• Preferred Ambulance LLC
• Premier Physical Therapy PC

• Registered Nurse in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.