Shirley Vernetha Willis III, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041-161525 Issued in IL

Practice address

13136 Western Ave
Blue Island, IL 60406-2423

Phone

(708) 974-5800

Fax

(708) 371-0466

NPI assigned

Jun 14, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308787200000",
    "number": "1285929620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13136 WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062423",
            "telephone_number": "708-974-5800",
            "fax_number": "708-371-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13136 WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062423",
            "telephone_number": "708-974-5800",
            "fax_number": "708-371-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHIRLEY",
        "middle_name": "VERNETHA",
        "name_prefix": "Miss",
        "name_suffix": "III",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041-161525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony West
• Takenya White
• Wholistic Healthcare Services, Inc.
• Barbara May Wieties-Malm, MD
• Sarah L Williams
• Alma Wingard
• Scott Charles Wirtanen, PHARMD
• Debra Witt, PT
• Miyoung Won, MD
• Laura Woodard

• Registered Nurse in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.