MEDICARE: MRS. SHANNON SMOTHERS-WANSLEY

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	246QM0706X	Medical Technologist

General Provider Information

NPI Number	:	1184581159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON SMOTHERS-WANSLEY

Provider Business Mailing Address
First Line	:	3205 SAINT CHARLES RD APT 1
Second Line	:
City	:	BELLWOOD
State	:	IL
Zip	:	60104-1574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 S 5TH AVE
Second Line	:
City	:	HINES
State	:	IL
Zip	:	60141-3030
Country	:	US
Telephone Number	:	708-202-8387
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/12/2026

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