NPI | 1295427490 |
---|---|
Former Name | STEPHANIE J WILSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 343989-4405) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 343989-4405) |
Enumeration Date | 2023-05-24 |
Last Update Date | 2025-09-18 |