Provider Demographics
NPI:1437263316
Name:WILSON, YVETTE T (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:T
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 S WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2629
Mailing Address - Country:US
Mailing Address - Phone:773-306-1230
Mailing Address - Fax:
Practice Address - Street 1:9831 S WESTERN AVE
Practice Address - Street 2:ADVOCATE MEDICAL GROUP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1791
Practice Address - Country:US
Practice Address - Phone:773-445-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49412Medicare UPIN
ILK49411Medicare UPIN