Healthcare Provider Details

I. General information

NPI: 1356603864
Provider Name (Legal Business Name): MYECIA RA'SHAWNDA HARRISON WILLIAMS RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYECIA RA'SHAWNDA HARRISON RN, APN

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 LINCOLN HWY CVS/MINUTE CLINIC
MOKENA IL
60448
US

IV. Provider business mailing address

1259 WEST 112TH STREET
CHICAGO IL
60643
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-2171
  • Fax:
Mailing address:
  • Phone: 708-299-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.009493
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: