Provider Demographics
NPI:1942915616
Name:WILLSON, HALEY (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:WILLSON
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 E 2400 AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62418-4111
Mailing Address - Country:US
Mailing Address - Phone:217-343-8802
Mailing Address - Fax:
Practice Address - Street 1:1802 E 2400 AVE
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62418-4111
Practice Address - Country:US
Practice Address - Phone:217-343-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041453831163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant