Individual
AMANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 E INDIAN SCHOOL RD APT 2119, PHOENIX, AZ 85012-1886
(480) 241-2197
Mailing address
1701 E MEADOWBROOK AVE APT 346, PHOENIX, AZ 85016-5113
(480) 241-2197
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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