Provider Demographics
NPI:1295953479
Name:WILTON, SUZANNE E (APN)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:E
Last Name:WILTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3510
Mailing Address - Country:US
Mailing Address - Phone:309-888-5531
Mailing Address - Fax:309-888-5530
Practice Address - Street 1:902 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3510
Practice Address - Country:US
Practice Address - Phone:309-888-5531
Practice Address - Fax:309-888-5530
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001962363LX0106X
IL209.001962363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care