Provider Demographics
NPI:1912466756
Name:WILD, CECILIA ANNE (APN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANNE
Last Name:WILD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:ANNE
Other - Last Name:QUIGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:15164 EYRE CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2433
Mailing Address - Country:US
Mailing Address - Phone:630-589-9375
Mailing Address - Fax:
Practice Address - Street 1:24600 W 127TH ST STE B325
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9527
Practice Address - Country:US
Practice Address - Phone:815-731-9100
Practice Address - Fax:815-731-9110
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019027363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health