Individual
DIANE EH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1937 W 5700 S, ROY, UT 84067-2303
(801) 773-9380
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 375-8858
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1832651205
UT
Other
Enumeration date
07/12/2006
Last updated
09/04/2012
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