Individual
MRS. MICHELLE J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
190 ADMIRAL COCHRANE DR, SUITE 180, ANNAPOLIS, MD 21401-7365
(410) 571-6411
(410) 571-6415
Mailing address
PO BOX 891, LAUREL, MD 20725-0891
(410) 571-6411
(410) 571-6415
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18232
MD
Other
Enumeration date
12/12/2007
Last updated
12/12/2007
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