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Individual
SUSAN R WILSON
Active
Individual
SUSAN R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704149259
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801119532
—
MI
Enumeration date
03/09/2010
Last updated
06/08/2016
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