Individual
CORA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1827 S 16TH AVE, BROADVIEW, IL 60155-3011
(708) 299-0746
Mailing address
1827 S 16TH AVE, BROADVIEW, IL 60155-3011
(708) 299-0746
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
TECHNICIAN/HOMECARE
—
Enumeration date
11/02/2022
Last updated
11/02/2022
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