Provider Demographics
NPI:1053748467
Name:COLEMAN-BLACKSHIRE, FELECIA TERESA (NP)
Entity type:Individual
Prefix:MRS
First Name:FELECIA
Middle Name:TERESA
Last Name:COLEMAN-BLACKSHIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:FELECIA
Other - Middle Name:TERESA
Other - Last Name:BLACKSHIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3235 W 84TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3306
Mailing Address - Country:US
Mailing Address - Phone:773-983-1337
Mailing Address - Fax:
Practice Address - Street 1:3235 W 84TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3306
Practice Address - Country:US
Practice Address - Phone:773-983-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008557363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care