Individual
IAN THOMAS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 NORTH AVE, GRAND JUNCTION, CO 81501-6428
(970) 242-0731
Mailing address
3231 LAKESIDE DR APT 203, GRAND JUNCTION, CO 81506-2846
(951) 743-9989
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9502163
CA
Other
Enumeration date
04/15/2022
Last updated
04/15/2022
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