Provider Demographics
NPI:1447016167
Name:BOHANNON, SHENIKA (RN-BSN)
Entity type:Individual
Prefix:
First Name:SHENIKA
Middle Name:
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 OLD MILL CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8981
Mailing Address - Country:US
Mailing Address - Phone:312-868-5450
Mailing Address - Fax:
Practice Address - Street 1:1136 S DELANO CT W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3740
Practice Address - Country:US
Practice Address - Phone:312-868-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041476061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse