Individual
HALEIGH D WADSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2718 N PROSPECT AVE, CHAMPAIGN, IL 61822-1298
(217) 337-3852
(217) 337-3853
Mailing address
2718 N PROSPECT AVE, CHAMPAIGN, IL 61822-1298
(217) 337-3852
(217) 337-3853
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019221
IL
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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