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:
Health care specialties
| Specialty | Code | License # | 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 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669510400 | NPPES |
| Illinois | MEDICAID | 036110740 |
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