Individual
NICHOLAS ROBERT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3456
Mailing address
420 DELAWARE STREET SE, MMC 284, MINNEAPOLIS, MN 55455
(612) 626-5454
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
70945
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2019
Last updated
04/20/2022
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