Provider Demographics
NPI:1538426127
Name:WILSON-PATTERSON, SHALONDA FELESA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHALONDA
Middle Name:FELESA
Last Name:WILSON-PATTERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20285 PROVIDENCE LN
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1066
Mailing Address - Country:US
Mailing Address - Phone:708-753-0651
Mailing Address - Fax:
Practice Address - Street 1:7300 191ST ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9361
Practice Address - Country:US
Practice Address - Phone:815-806-3210
Practice Address - Fax:815-469-0910
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily