Organization
WISTERIA HEALTH SERVICES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERIE WATSON APN (PRESIDENT)
(309) 221-1678
Entity
Organization
Contact information
Practice address
12860 E LYONS RD, LONDON MILLS, IL 61544-9393
(309) 221-1678
Mailing address
12860 E LYONS RD, LONDON MILLS, IL 61544-9393
(309) 221-1678
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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