Individual
CAWONDA RANEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
2501 CHATHAM RD, SPRINGFIELD, IL 62704-4188
(253) 922-4027
(844) 222-0800
Mailing address
6823 SUSSEX RD, TINLEY PARK, IL 60477-1745
(708) 682-4748
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2023032312
IL
2084P0805X
Geriatric Psychiatry Physician
041469714
IL
363L00000X
Nurse Practitioner
209027707
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023032312
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209027707
ADVANCED NURSE PRACTITIONER
IL
Enumeration date
05/15/2023
Last updated
05/02/2024
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