Provider Demographics
NPI:1144264102
Name:WILSON, SHEILA RENEA (PERSONAL ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:RENEA
Last Name:WILSON
Suffix:
Gender:F
Credentials:PERSONAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:IL
Mailing Address - Zip Code:61610-3206
Mailing Address - Country:US
Mailing Address - Phone:309-698-8961
Mailing Address - Fax:
Practice Address - Street 1:5533 N GALENA RD
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-4461
Practice Address - Country:US
Practice Address - Phone:309-282-2073
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant