Active NPI
Cora Wilson
- Other Technician
- Broadview, IL
National Provider Identifier
1497462097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 1827 S 16TH Ave
Broadview, IL 60155-3011 - Phone
- (708) 299-0746
- NPI assigned
- Nov 2, 2022
- Last updated
- Nov 2, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | IL | Primary |
Addresses
Primary practice location
1827 S 16TH Ave
Broadview, IL 60155-3011
Mailing address
1827 S 16TH Ave
Broadview, IL 60155-3011
Phone (708) 299-0746
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | TECHNICIAN/HOMECARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667347200000",
"number": "1497462097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1827 S 16TH AVE",
"city": "BROADVIEW",
"state": "IL",
"postal_code": "601553011",
"telephone_number": "708-299-0746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1827 S 16TH AVE",
"city": "BROADVIEW",
"state": "IL",
"postal_code": "601553011",
"telephone_number": "708-299-0746"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CORA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-02",
"last_updated": "2022-11-02",
"certification_date": "2022-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TECHNICIAN/HOMECARE",
"identifier": "NONE",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Broadview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.