Provider Demographics
NPI:1376086629
Name:WIND, SHAYLAN
Entity Type:Individual
Prefix:MISS
First Name:SHAYLAN
Middle Name:
Last Name:WIND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-5743
Mailing Address - Country:US
Mailing Address - Phone:309-427-0293
Mailing Address - Fax:
Practice Address - Street 1:502 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-5743
Practice Address - Country:US
Practice Address - Phone:309-427-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1424676376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide