Individual
MR. DAVID DWAYNE WILSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN-RN-BC
Contact information
Practice address
1301 LYNN ST, HIGHLAND, IL 62249-2265
(618) 604-4088
Mailing address
1301 LYNN ST, HIGHLAND, IL 62249-2265
(618) 604-4088
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
041383761
IL
Other
Enumeration date
04/28/2013
Last updated
04/28/2013
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