Provider Demographics
NPI:1588008940
Name:WILSON, DAVID DWAYNE II (BSN-RN-BC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DWAYNE
Last Name:WILSON
Suffix:II
Gender:M
Credentials:BSN-RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2265
Mailing Address - Country:US
Mailing Address - Phone:618-604-4088
Mailing Address - Fax:
Practice Address - Street 1:1301 LYNN ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2265
Practice Address - Country:US
Practice Address - Phone:618-604-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041383761163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical