Healthcare Provider Details

I. General information

NPI: 1003749250
Provider Name (Legal Business Name): SHANIKA L WILSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 WOLVERTON LN APT D
ROCKFORD IL
61109-5549
US

IV. Provider business mailing address

1519 13TH ST
ROCKFORD IL
61104-5424
US

V. Phone/Fax

Practice location:
  • Phone: 815-987-7620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: