Provider Demographics
NPI:1346674579
Name:WILSON, DENISE RENA (APN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENA
Last Name:WILSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15929 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6707
Mailing Address - Country:US
Mailing Address - Phone:708-745-5600
Mailing Address - Fax:815-300-3778
Practice Address - Street 1:15929 S BELL RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6707
Practice Address - Country:US
Practice Address - Phone:708-745-5600
Practice Address - Fax:815-300-3778
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000402364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health