MEDICARE: MRS. CHERYL WILSON R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	041.139324	IL

General Provider Information

NPI Number	:	1922237619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL WILSON R.N.

Provider Business Mailing Address
First Line	:	746 COUNTY ROAD 625 N
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4007
Country	:	US
Telephone Number	:	217-849-3857
Fax Number	:	217-849-3434

Provider Business Practice Location Address
First Line	:	200 N ILLINOIS ST
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-1034
Country	:	US
Telephone Number	:	217-849-3000
Fax Number	:	217-849-3434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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