Provider Demographics
NPI:1457133787
Name:WILLIAMS, TAWANA MONIQUE (MSN, APN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:MONIQUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSN, APN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14426 S PARNELL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827-2632
Mailing Address - Country:US
Mailing Address - Phone:312-623-9054
Mailing Address - Fax:
Practice Address - Street 1:201 E OGDEN AVE STE 118
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3776
Practice Address - Country:US
Practice Address - Phone:630-270-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner