Individual
SHENYKA MICOLE WHEATLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
925 WEST STREET, PERU, IL 61354
(888) 632-0543
Mailing address
9001 S PAULINA, CHICAGO, IL 60620
(773) 738-2831
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.004736
IL
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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