Provider Demographics
NPI:1275361685
Name:WILSON, HOSIE SHANDELL
Entity type:Individual
Prefix:MR
First Name:HOSIE
Middle Name:SHANDELL
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18738 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3526
Mailing Address - Country:US
Mailing Address - Phone:708-682-7787
Mailing Address - Fax:
Practice Address - Street 1:2171 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:DIXMOOR
Practice Address - State:IL
Practice Address - Zip Code:60426-1019
Practice Address - Country:US
Practice Address - Phone:630-240-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide