Provider Demographics
NPI:1487496113
Name:WEATHERSPOON, SHELENCIA (FNP)
Entity type:Individual
Prefix:
First Name:SHELENCIA
Middle Name:
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 OLD GLENVIEW RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2964
Mailing Address - Country:US
Mailing Address - Phone:847-673-6505
Mailing Address - Fax:847-673-2099
Practice Address - Street 1:3201 OLD GLENVIEW RD STE 130
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2964
Practice Address - Country:US
Practice Address - Phone:847-673-6505
Practice Address - Fax:847-673-2099
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030219363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily