Individual
LISA CHARIVUKALAYIL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7741 W CATALPA AVE, CHICAGO, IL 60656-1638
(773) 808-9330
Mailing address
7741 W CATALPA AVE, CHICAGO, IL 60656-1638
(773) 808-9330
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209032604
IL
Other
Enumeration date
06/24/2025
Last updated
06/24/2025
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