Individual
AMANDA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
19950 S PRAIRIE RD E, BONNEY LAKE, WA 98391-7901
(253) 862-1555
(253) 862-1557
Mailing address
19950 S PRAIRIE RD E, BONNEY LAKE, WA 98391-7901
(253) 862-1555
(253) 862-1557
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00022187
WA
Other
Enumeration date
03/08/2007
Last updated
01/03/2012
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