Individual
AMY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2906 W MURPHYSBORO RD, CARBONDALE, IL 62901-1060
(314) 642-1037
Mailing address
2906 W MURPHYSBORO RD, CARBONDALE, IL 62901-1060
(314) 642-1037
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
105739
AK
Other
Enumeration date
11/25/2015
Last updated
11/25/2015
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