MEDICARE: SHEILA ANITRA WRIGHT APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209015194	IL

General Provider Information

NPI Number	:	1104321645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA ANITRA WRIGHT APN

Provider Business Mailing Address
First Line	:	1317 S PLYMOUTH CT UNIT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3366
Country	:	US
Telephone Number	:	312-218-7378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 S PLYMOUTH CT UNIT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3366
Country	:	US
Telephone Number	:	312-218-7378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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