Provider Demographics
NPI:1184614737
Name:WALICEK, SHARON HENRY (APN, NP-BC, CCNS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:HENRY
Last Name:WALICEK
Suffix:
Gender:F
Credentials:APN, NP-BC, CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W 113 SHANNON SQ
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134
Mailing Address - Country:US
Mailing Address - Phone:630-845-8373
Mailing Address - Fax:
Practice Address - Street 1:915 CENTER ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2106
Practice Address - Country:US
Practice Address - Phone:847-931-4200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203481Medicare ID - Type Unspecified
ILP76089Medicare UPIN