Healthcare Provider Details

I. General information

NPI: 1396667176
Provider Name (Legal Business Name): SHARHONDA JEAN TERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 177TH ST
LANSING IL
60438-1720
US

IV. Provider business mailing address

2235 177TH ST
LANSING IL
60438-1720
US

V. Phone/Fax

Practice location:
  • Phone: 312-434-8940
  • Fax:
Mailing address:
  • Phone: 312-434-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041387821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: