Provider Demographics
NPI:1396577565
Name:WILSON, MARIA LOURDES (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 N LAKE SHORE DR APT 315
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1902
Mailing Address - Country:US
Mailing Address - Phone:773-807-3385
Mailing Address - Fax:
Practice Address - Street 1:3550 N LAKE SHORE DR APT 315
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1902
Practice Address - Country:US
Practice Address - Phone:773-807-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041439466163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine