Wilson, Jill Bethany

Wilson, Jill Bethany is an individual health care provider with primary practice located at 409 W Oak St , Carbondale IL 62901. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Wilson, Jill Bethany can be contacted via phone (618) 529-4455.

Contact Information

Primary practice address
409 W Oak St Carbondale IL 62901
Phone: (618) 529-4455
Fax: (618) 351-1287
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209009467 Illinois

Profile Details

NPI number 1326314634
LBN Legal business name Wilson, Jill Bethany
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2012
Last updated Oct 6th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326314634 NPPES
Illinois MEDICAID 370966854005
Illinois Other CF3444
Illinois MEDICAID 370966854002
Illinois Other 209.009467

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