Individual
MS. E JOAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLS
Contact information
Practice address
12000 STONE LAKE ROAD, DULCE, NM 87528
(505) 759-7238
Mailing address
PO BOX 1403, OCEAN PARK, WA 98640
(360) 665-4599
Taxonomy
Speciality
Code
Description
License number
State
246ZI1000X
Medical Illustrator
Primary
9905528
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
06/03/2008
Last updated
06/04/2008
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