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Individual

MS. MARY S WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
92-8691 LOTUS BLOSSOM LANE 6&7, 92-8691 LOTUS BLOSSOM LANE 6&7, OCEAN VIEW, HI 96737-9673
(808) 939-8100
(808) 829-3672
Mailing address
PO BOX 6065, OCEAN VIEW, HI 96737-6065
(808) 939-8100

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN-1997
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10106478
VA
05
1073531687
VA
Enumeration date
07/18/2006
Last updated
02/21/2019
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