Provider Demographics
NPI:1134584725
Name:WILLSON, BARBARA F (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:F
Last Name:WILLSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 WILLOW SPRINGS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6557
Mailing Address - Country:US
Mailing Address - Phone:708-245-8120
Mailing Address - Fax:708-245-8119
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 150
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6557
Practice Address - Country:US
Practice Address - Phone:708-245-8120
Practice Address - Fax:708-245-8119
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant