Individual
NICHOLAS ANTHONY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1020 N 12TH ST, MILWAUKEE, WI 53233-1308
(414) 773-4312
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
81247-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100255025
—
WI
Enumeration date
03/28/2019
Last updated
12/19/2023
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