Individual
KATIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-4364
Mailing address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-4364
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209.016522
IL
Other
Enumeration date
09/08/2017
Last updated
03/05/2019
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