Individual
NATALIE JOAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1463 US HWY 61, SUITE C, FESTUS, MO 63028-6302
(314) 596-6541
(636) 933-2910
Mailing address
1463 US HIGHWAY 61 STE C, FESTUS, MO 63028-4160
(314) 596-6541
(636) 933-2190
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2020010590
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013015912
RN
MO
01
—
2020010590
PNCB CERTIFICATION NUMBER
MO
Enumeration date
08/04/2020
Last updated
08/04/2020
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