DR. SUZAN CATHLEEN SHANE-GRAY (NPI# 1144525452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144525452 |
| Entity Type | Individual |
| Full Name | DR. SUZAN CATHLEEN SHANE-GRAY |
| Credential | APN, EDD |
| Practice Address |
530 Ne Glen Oak Ave Pob 113 Peoria IL 61637-0001 |
| Practice Telephone | 3092248683 |
| Mailing Telephone | 3092248683 |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-01-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0200X |
Clinical Nurse Specialist Specialization: Pediatrics |
209.008562 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
530 NE GLEN OAK AVE POB 113 |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
| 1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
| 1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
| 1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
| 1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
| 1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
| 1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
| 1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 364SP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083062285 | Heather A Boore | Clinical Nurse Specialist | 420 Ne Glen Oak Ave, Suite 401, Peoria, IL 61603 | 2016-05-27 |
| 1790139384 | Jenna Ford | Clinical Nurse Specialist | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2016-04-20 |
| 1669897930 | Kristine Michelle Papis | Clinical Nurse Specialist | 320 E Armstrong Ave, Peoria, IL 61603-3172 | 2014-02-24 |
| 1114348620 | Sarah E Dominique | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2013-12-31 |
| 1396183786 | Amy Zimmerman | Clinical Nurse Specialist | 507 E Armstrong Ave, Peoria, IL 61603-3201 | 2013-06-07 |
| 1700155793 | Kristie Taggart | Clinical Nurse Specialist | 420 Ne Glen Oak Ave, Peoria, IL 61603-3105 | 2011-12-20 |
| 1902136856 | Maureen Whalen Hofmann | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2009-12-28 |
| 1558393751 | Tara Walker | Clinical Nurse Specialist | 14155 N 83rd Ave, Suite #110, Peoria, AZ 85381-5639 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962666123 | Sharon Marie Coyer | Clinical Nurse Specialist | 534 Brownstone Dr, St Charles, IL 60174-2807 | 2008-07-16 |
| 1760646962 | Thelma P. Reed | Clinical Nurse Specialist | 326 .west 64th St., Suite 412, Chicago, IL 60621-1334 | 2008-07-16 |
| 1871711283 | Jeannine Marie Cheatham | Clinical Nurse Specialist | 5841 S Maryland Ave # Mc4064, Room C146, Chicago, IL 60637-1447 | 2007-04-23 |
| 1578649372 | Renee C.b. Manworren | Clinical Nurse Specialist | 225 E. Chicago Avenue, Box 47, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611-2991 | 2006-10-27 |
| 1679594014 | Therese Nancy Coha | Clinical Nurse Specialist | 2300 N Childrens Plz # 63, Chicago, IL 60614-3363 | 2006-07-21 |
| 1164908992 | Megan Hughes | Clinical Nurse Specialist | 1775 W Dempster St, Park Ridge, IL 60068-1143 | 2018-07-16 |
| 1508381161 | Nicholette M Andrews | Clinical Nurse Specialist | 355 E Erie St, Chicago, IL 60611-3167 | 2017-08-04 |
| 1043684533 | Gabriel Campos | Clinical Nurse Specialist | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2015-11-20 |
| 1376937474 | Rona Tiglao | Clinical Nurse Specialist | 1725 W Harrison St, Suite 710, Chicago, IL 60612-3841 | 2015-03-26 |
| 1992196380 | Kimberly Duback | Clinical Nurse Specialist | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2015-02-06 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. SUZAN CATHLEEN SHANE-GRAY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.