Provider Demographics
NPI:1588437263
Name:WILSON-BOUIE, SHARESE
Entity type:Individual
Prefix:
First Name:SHARESE
Middle Name:
Last Name:WILSON-BOUIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 MERRIMAC LN N
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-6212
Mailing Address - Country:US
Mailing Address - Phone:630-641-3950
Mailing Address - Fax:
Practice Address - Street 1:1490 MERRIMAC LN N
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-6212
Practice Address - Country:US
Practice Address - Phone:630-641-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker