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Individual
AUDRA LYNN WILSON
Active
Individual
AUDRA LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1661274
ID
363A00000X
Physician Assistant
PA61338060
WA
363AS0400X
Surgical Physician Assistant
PA61338060
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2215177
—
WA
Enumeration date
03/08/2021
Last updated
12/10/2024
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