| Doctor Name: | DENISE RENA WILSON |
| NPI Number: | 1346674579 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 209.008836 |
| Business Practice Address: | 15929 S Bell Rd Homer Glen, IL - 604916707 |
| Business Phone Number: | 7087455600 |
| Business Fax Number: | 8153003778 |
| Mailing Address: | 15929 S Bell Rd, HOMER GLEN |
| State: | IL |
| Postal Code: | 604916707 |
| Phone Number: | 7087455600 |
| Fax Number: | 8153003778 |
| NPI Enumeration Date: | 08/23/2013 |
| NPI Last Update Date: | 09/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SA2200X |
| License Number: | 209.008836 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |