1336161793 NPI number — DR. CAROL JO WILSON PHD, APRN, CFNP

Table of content: DR. CAROL JO WILSON PHD, APRN, CFNP (NPI 1336161793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336161793 NPI number — DR. CAROL JO WILSON PHD, APRN, CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
CAROL
Provider Middle Name:
JO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, APRN, CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336161793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 WILCOX ST
Provider Second Line Business Mailing Address:
UNIVERSITY OF ST. FRANCIS
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-6169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-470-3859
Provider Business Mailing Address Fax Number:
815-740-4243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 WILCOX ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF ST. FRANCIS
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-6169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-470-3859
Provider Business Practice Location Address Fax Number:
815-740-4243
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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