Individual
AMBER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25 N WINFIELD RD STE 424, WINFIELD, IL 60190-1379
(630) 933-4056
(630) 933-4057
Mailing address
25 N WINFIELD RD STE 424, WINFIELD, IL 60190-1379
(630) 933-4056
(630) 933-4057
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005692
IL
363AM0700X
Medical Physician Assistant
5601005578
MI
363AM0700X
Medical Physician Assistant
MA056675
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376776831
—
MI
01
—
1417961137
BCBSM - BATTLE CREEK
MI
Enumeration date
09/01/2009
Last updated
05/11/2021
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