Healthcare Provider Details

I. General information

NPI: 1497675953
Provider Name (Legal Business Name): SHERRICE NICOLE CLINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 EUCLID AVE
BERWYN IL
60402-3662
US

IV. Provider business mailing address

3551 EUCLID AVE
BERWYN IL
60402-3662
US

V. Phone/Fax

Practice location:
  • Phone: 312-889-8979
  • Fax:
Mailing address:
  • Phone: 312-889-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041382343
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: