Provider Demographics
NPI:1578688578
Name:WEBB, SHARITA I
Entity Type:Individual
Prefix:MRS
First Name:SHARITA
Middle Name:
Last Name:WEBB
Suffix:I
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 1:7931 SOUTH ARTESIAN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1714
Mailing Address - Country:US
Mailing Address - Phone:773-863-0019
Mailing Address - Fax:773-863-0025
Practice Address - Street 1:7931 S ARTESIAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1714
Practice Address - Country:US
Practice Address - Phone:773-863-0019
Practice Address - Fax:773-863-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILSW05490401P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist