Individual
DESTINY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1300 N MARKET ST, SPARTA, IL 62286-1048
(618) 443-1337
(618) 443-1383
Mailing address
1300 N MARKET ST, SPARTA, IL 62286-1048
(618) 443-1337
(618) 443-1383
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209015177
IL
Other
Enumeration date
12/13/2016
Last updated
06/04/2020
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