Organization
ESSENTIAL HEALTH SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WILSON APRN (CLINIC DIRECTOR)
(872) 444-3420
Entity
Organization
Contact information
Practice address
1750 E 87TH ST STE 101, CHICAGO, IL 60617-2706
(872) 444-3420
(630) 566-3467
Mailing address
8833 S CRANDON AVE, CHICAGO, IL 60617-3051
(312) 590-1975
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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