Individual
ANGELA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1701 W GARDEN ST, PEORIA, IL 61605-3531
(309) 680-7600
Mailing address
1514 SUMMER ST, PEKIN, IL 61554-5643
(309) 453-4688
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
209032904
IL
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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