Provider Demographics
NPI:1376420042
Name:MCSHAN, AVERY NATASHA (CD)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:NATASHA
Last Name:MCSHAN
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1333
Mailing Address - Country:US
Mailing Address - Phone:708-336-8784
Mailing Address - Fax:
Practice Address - Street 1:143 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1333
Practice Address - Country:US
Practice Address - Phone:708-336-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL080225374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula