Provider Demographics
NPI:1043845084
Name:GLADSON, SHANELL RENA (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHANELL
Middle Name:RENA
Last Name:GLADSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SHANELL
Other - Middle Name:RENA
Other - Last Name:REYNOLDS-GLADSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:4615 CORREL AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-2618
Mailing Address - Country:US
Mailing Address - Phone:309-453-0688
Mailing Address - Fax:309-324-5977
Practice Address - Street 1:4615 CORREL AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-2618
Practice Address - Country:US
Practice Address - Phone:309-453-0688
Practice Address - Fax:309-324-5977
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04105255163W00000X
IL2090315792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No163W00000XNursing Service ProvidersRegistered Nurse