Basic Information
Provider Information
NPI: 1366092843
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHARES
FirstName: JULIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6N030 FERSON WOODS DR
Address2:  
City: ST CHARLES
State: IL
PostalCode: 601756111
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 140 E LOOP RD
Address2:  
City: WHEATON
State: IL
PostalCode: 601898407
CountryCode: US
TelephoneNumber: 3122438487
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2019
LastUpdateDate: 09/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X527354ILY    

No ID Information.


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