| 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 |