Provider Demographics
NPI:1831676014
Name:WILSON-MILLS, ISHMAELLA R (APN)
Entity Type:Individual
Prefix:MS
First Name:ISHMAELLA
Middle Name:R
Last Name:WILSON-MILLS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ISHMAELLA
Other - Middle Name:R
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:708-422-7816
Practice Address - Street 1:9125 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1441
Practice Address - Country:US
Practice Address - Phone:708-422-7715
Practice Address - Fax:708-422-7816
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209018110OtherIL LICENSE