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Individual
KATHLEEN WILSON
Active
Individual
KATHLEEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1433
ME
363AS0400X
Surgical Physician Assistant
0098561
NY
363AS0400X
Surgical Physician Assistant
Primary
PA1433
ME
Other
Enumeration date
08/25/2006
Last updated
04/01/2019
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