Individual
ANNISE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036143070
IL
2084N0400X
Neurology Physician
125.063652
IL
2084N0400X
Neurology Physician
R6505
TX
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
036143070
IL
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
Primary
R6505
TX
Other
Enumeration date
03/24/2013
Last updated
12/04/2020
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