Individual
MRS. SHANNON ELAINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
326 N 7TH ST, SPRINGFIELD, IL 62701-1014
(217) 544-6464
(217) 522-1206
Mailing address
401 AINTREE CHASE, SHERMAN, IL 62684-9519
(217) 899-0807
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
IL
Other
Enumeration date
04/22/2007
Last updated
07/08/2007
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