Individual
DEBORA FON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 TIFFANY PT, BLOOMINGDALE, IL 60108-2936
(630) 924-1160
Mailing address
3827 MUNSON CT, PLANO, IL 60545-2214
(708) 785-6614
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
041403714
IL
Other
Enumeration date
03/07/2021
Last updated
03/07/2021
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