Shanna Marie Widera, RN, APN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209004579 Issued in IL

Practice address

225 E Chicago Ave
Box #59
Chicago, IL 60611-2991

Phone

(312) 227-6778

Fax

(312) 227-9413

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

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)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lurie Children'S Medical Group, LLC

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1992758544
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1790710531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 N DEARBORN ST APT 603N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606108375",
            "telephone_number": "773-398-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE",
            "address_2": "BOX #59",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "312-227-6778",
            "fax_number": "312-227-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDERA",
        "first_name": "SHANNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "RN, APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209004579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jancey Lee Wickstrom, MA, LCSW
• Elizabeth Kilner Wickware, O.D.
• Lauren Elizabeth Widaman
• Thomas A Widell, M.D.
• Ronald Roger Widen, DDS
• Abbie Claire Widing, RD
• Kristen Widing, LSW
• Victoria Widlak, PHARMD
• Annie Laurie Widlicka, MS, RD, LDN
• Kassie Widmyer, LCSW

• Pediatric Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; 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.