Individual
KATHRYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1505 EASTLAND DR, BLOOMINGTON, IL 61701-3534
(309) 661-2368
(309) 662-9709
Mailing address
1505 EASTLAND DR, BLOOMINGTON, IL 61701-3534
(309) 661-2368
(309) 662-9709
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036110277
IL
208M00000X
Hospitalist Physician
036110277
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110277
—
IL
Enumeration date
08/05/2006
Last updated
07/09/2025
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