Provider Demographics
NPI:1295214898
Name:COLEMAN-LENIOR, WONA J (NP)
Entity Type:Individual
Prefix:
First Name:WONA
Middle Name:J
Last Name:COLEMAN-LENIOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8439 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6213
Mailing Address - Country:US
Mailing Address - Phone:773-502-2378
Mailing Address - Fax:773-994-5983
Practice Address - Street 1:8439 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6213
Practice Address - Country:US
Practice Address - Phone:773-502-2378
Practice Address - Fax:773-994-5983
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner