Individual
JESSICA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DHS
Contact information
Practice address
27 AUERBACH PL, GLEN CARBON, IL 62034-1596
(618) 205-4242
Mailing address
27 AUERBACH PL, GLEN CARBON, IL 62034-1596
(618) 205-4242
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
043.116724
IL
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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