Provider Demographics
NPI:1356603864
Name:HARRISON WILLIAMS, MYECIA RA'SHAWNDA (RN, APN)
Entity type:Individual
Prefix:MRS
First Name:MYECIA
Middle Name:RA'SHAWNDA
Last Name:HARRISON WILLIAMS
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:MYECIA
Other - Middle Name:RA'SHAWNDA
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, APN
Mailing Address - Street 1:1259 WEST 112TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:708-299-0530
Mailing Address - Fax:
Practice Address - Street 1:11200 LINCOLN HWY
Practice Address - Street 2:CVS/MINUTE CLINIC
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:815-464-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily