Organization
LTC PRACTITIONERS OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE E. WILSON APN (NURSE PRACTITIONER)
(773) 401-4412
Entity
Organization
Contact information
Practice address
3915 N. KENNETH AVE., CHICAGO, IL 60641-2816
(773) 401-4412
(312) 492-6269
Mailing address
3915 N KENNETH AVE, CHICAGO, IL 60641-2816
(773) 401-4412
(312) 492-6269
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
209009340
IL
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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