Shannon Denise Moore, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

43074378 Issued in IL

Practice address

11191 Illinois Route 185
Hillsboro, IL 62049-2664

Phone

(217) 532-2001

Fax

(217) 532-6361

NPI assigned

Jul 24, 2007

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185235200000",
    "number": "1861692022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11191 ILLINOIS ROUTE 185",
            "city": "HILLSBORO",
            "state": "IL",
            "postal_code": "620492664",
            "telephone_number": "217-532-2001",
            "fax_number": "217-532-6361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11191 ILLINOIS ROUTE 185",
            "city": "HILLSBORO",
            "state": "IL",
            "postal_code": "620492664",
            "telephone_number": "217-532-2001",
            "fax_number": "217-532-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHANNON",
        "middle_name": "DENISE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "43074378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Mekala, PT
• Sharmila Mekala, OTR/L
• Amber Tennille Mifflin, C.A.D.C.
• Montgomery County Health Department
• Brian Moore, OD
• Mark Moranville, M.A.
• Barbara A. Mulch, M.D.
• Robert F. Mulch Jr., M.D.
• Michelle Elizabeth Noe, B.S.
• Andrew J Ott, D.P.M.

• Licensed Practical Nurse in Hillsboro, IL
• Providers in Hillsboro, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; 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.