Provider Demographics
NPI:1871923235
Name:SHOPINSKI, JENNIFER MARIE (APN, CNM, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SHOPINSKI
Suffix:
Gender:F
Credentials:APN, CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5950
Mailing Address - Country:US
Mailing Address - Phone:618-997-5266
Mailing Address - Fax:618-997-5285
Practice Address - Street 1:202 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1409
Practice Address - Country:US
Practice Address - Phone:618-457-0465
Practice Address - Fax:618-457-8022
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010405367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF3444OtherMEDICARE RAILROAD
IL370966854017Medicaid
IL640701Medicare Oscar/Certification
IL141970Medicare Oscar/Certification