Ebonie Leah Williams, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209016638 Issued in IL

Practice address

11641 Sundance TRL
Mokena, IL 60448-2451

Phone

(708) 715-2035

NPI assigned

Sep 25, 2017

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mind Revival Psych Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1043182280
  Medicare reassignment NPD Authorized official
• Family Doc, Inc.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1700117942
  Medicare reassignment NPD
• Familydoc Urgent Care LLC

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1245880715
  Medicare reassignment NPD

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506297600000",
    "number": "1871002675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11641 SUNDANCE TRL",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482451",
            "telephone_number": "708-715-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11641 SUNDANCE TRL",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482451",
            "telephone_number": "708-715-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "EBONIE",
        "middle_name": "LEAH",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2017-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209016638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wheelchair Sales & Service, Inc.
• White Oak Institute for Growth and Wellness LLC
• Melissa Whitman, CRNA
• Samantha Wiles
• Amber Rae Wilkins, M.A., SLP, CCC
• Valerie Williams, P.T., D.P.T.
• Eleanor Grace Wilson
• Krystal Wilson
• Kimberly S Winkelman, BCBA
• Wyatt Winn

• Family Nurse Practitioner in Mokena, IL
• Providers in Mokena, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.