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General NPI Number Information
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NPI Number | 1558162719
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Entity Type | Individual
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Provider Name | CHE-IA D DONELY-WILSON RN
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 141 W 46TH AVE
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City | GARY
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State | IN
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Zip | 46408-3905
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Country | US
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Telephone | 312-785-3863
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Fax |
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Provider Business Mailing Address
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Address Line | 141 W 46TH AVE
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City | GARY
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State | IN
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Zip | 46408-3905
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Country | US
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Telephone | 312-785-3863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0500X
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Taxonomy Name | Hemodialysis Registered Nurse
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License Number | 041.4622619
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 041.462619
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 28279273A
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License Number State | IN
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