Individual
DR. EDWINA C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
833 BUFFALO ST, SUITE 200, FARMVILLE, VA 23901-1111
(434) 392-8177
(434) 392-8272
Mailing address
833 BUFFALO ST, SUITE 200, FARMVILLE, VA 23901-1111
(434) 392-8177
(434) 392-8272
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101045725
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900615
—
NC
01
—
88245
BLUE CROSS BLUE SHIELD
NC
Enumeration date
08/11/2005
Last updated
11/18/2013
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