| NPI | 1942535570 |
|---|---|
| Former Name | STEFANIE LYNN WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1496) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2024-10-31 |