Individual
TIFFANY S WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
24 S WEBER ST STE 200, COLORADO SPRINGS, CO 80903-1928
(866) 226-8576
Mailing address
7046 HOLLYWOOD BLVD APT 204, LOS ANGELES, CA 90028-6058
(818) 739-9892
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-2707834
—
CO
Enumeration date
09/13/2021
Last updated
09/13/2021
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