Individual
ELIZABETH ARDITH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2204 EASTLAND DR, BLOOMINGTON, IL 61704-3567
(309) 661-6900
(309) 661-6991
Mailing address
611 W PARK, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004145
IL
363AM0700X
Medical Physician Assistant
085-004145
IL
Other
Enumeration date
11/16/2011
Last updated
03/14/2025
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