Individual
MRS. AMY M WILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
5201 WILLOW SPRINGS RD, SUITE 180, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 579-9705
(708) 579-0346
Mailing address
5201 WILLOW SPRINGS RD, SUITE 180, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 579-9705
(708) 579-0346
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31600057
BC/BS
IL
Enumeration date
09/25/2006
Last updated
04/09/2008
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