Wisdom, Lucy Nelson

Wisdom, Lucy Nelson is an individual health care provider with primary practice located at 1404 Eastland Drive Suite 204, Bloomington IL 61701. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Wisdom, Lucy Nelson can be contacted via phone (309) 662-8813.

Contact Information

Primary practice address
1404 Eastland Drive Suite 204 Bloomington IL 61701
Phone: (309) 662-8813
Fax: (309) 662-6835
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 036110740 Illinois

Profile Details

NPI number 1669510400
LBN Legal business name Wisdom, Lucy Nelson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2007
Last updated Jul 8th, 2007 - about 17 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 1669510400 NPPES
Illinois MEDICAID 036110740

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