Provider Demographics
NPI:1942596101
Name:WILSON, SHONIA KENYYA (CNA)
Entity Type:Individual
Prefix:MS
First Name:SHONIA
Middle Name:KENYYA
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9128
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60598-9128
Mailing Address - Country:US
Mailing Address - Phone:630-877-0966
Mailing Address - Fax:630-618-3788
Practice Address - Street 1:792 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7345
Practice Address - Country:US
Practice Address - Phone:630-877-0966
Practice Address - Fax:630-618-3788
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide