Individual
JEROME LAURENCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9650 GROSS POINT RD, SKOKIE, IL 60076-5080
(847) 676-1112
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085001943
IL
363AS0400X
Surgical Physician Assistant
Primary
10002805A
IN
Other
Enumeration date
09/26/2006
Last updated
02/26/2026
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