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General NPI Number Information
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NPI Number | 1003749250
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Entity Type | Individual
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Provider Name | SHANIKA L WILSON CNA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2026
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Last Update Date | 06/06/2026
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Provider Practice Location Address
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Address Line | 4749 WOLVERTON LN APT D
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City | ROCKFORD
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State | IL
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Zip | 61109-5549
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Country | US
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Telephone | 815-987-7620
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 13TH ST
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City | ROCKFORD
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State | IL
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Zip | 61104-5424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | IL
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