Healthcare Provider Details

I. General information

NPI: 1215795273
Provider Name (Legal Business Name): CHLOE WILSON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 KILMARON CIR
HENDERSON NV
89014-2214
US

IV. Provider business mailing address

2559 KILMARON CIR
HENDERSON NV
89014-2214
US

V. Phone/Fax

Practice location:
  • Phone: 312-890-5851
  • Fax:
Mailing address:
  • Phone: 312-890-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberRC3322
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRC3322
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: