Provider Demographics
NPI:1447304431
Name:HUANG, DORIS SHUWEN (FNP)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:SHUWEN
Last Name:HUANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHUWEN
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 7513
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-7513
Mailing Address - Country:US
Mailing Address - Phone:312-925-7013
Mailing Address - Fax:
Practice Address - Street 1:5130 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4332
Practice Address - Country:US
Practice Address - Phone:773-921-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003913363LF0000X
IL209003913363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400145113OtherMEDICARE PTA
ILF400145113OtherMEDICARE PTA
ILQ13983Medicare UPIN