Individual
LAURA L WILSON-BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
7309 N KNOXVILLE AVE, PEORIA, IL 61614-2085
(309) 692-9898
(309) 692-9055
Mailing address
7309 N KNOXVILLE AVE, STE 200, PEORIA, IL 61614-2085
(309) 691-6225
(309) 691-7635
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085003443
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003443
LICENSE
IL
Enumeration date
03/16/2009
Last updated
11/07/2016
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