Terri Nannette Shumway, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209-004693 Issued in IL

Practice address

8600 N. Route 91
Peoria, IL 61615-1111

Phone

(309) 683-5050

Fax

(309) 683-5335

NPI assigned

Aug 30, 2006

Last updated

Jun 6, 2013By the provider in NPPES

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

Other identifiers 7

Other names 1

• Terri Nannette Burgener Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Wound Care LLC

  • Nurse Practitioner
  • Springfield, IL
  • NPI 1528084266
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1972612836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 N. ROUTE 91",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616150001",
            "telephone_number": "309-683-5050",
            "fax_number": "309-683-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 N. ROUTE 91",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151111",
            "telephone_number": "309-683-5050",
            "fax_number": "309-683-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMWAY",
        "first_name": "TERRI",
        "middle_name": "NANNETTE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-004693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "0005832068",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "213056",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "30-0024900",
            "identifier": "TAX ID",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE INDIVIDUAL PI",
            "identifier": "P00332136",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1528084266",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972612836",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP #",
            "identifier": "DE5770",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRI",
            "last_name": "BURGENER",
            "middle_name": "NANNETTE",
            "credential": "APN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kumarpal Shrishrimal, MD
• Rahia P Shuaib, MD
• Caytlyn Shubert
• Cynthia Shuckford
• Chirayu Shukla
• Lyuba Z Shur, LCPC
• Ampem Darko JNR Siaw, M.B.,CH.B
• Steven E Sicher, M.D.
• Julie A Sidak, MS
• Nikhut Siddique

• Nurse Practitioner in Peoria, IL
• Providers in Peoria, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; 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.