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Individual
CAROL WILBURN
Active
Individual
CAROL WILBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10133
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1714551
—
LA
Enumeration date
09/20/2006
Last updated
12/17/2007
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