Individual
DONNA C. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
510 HIGHWAY 32, LEBANON, MO 65536-5303
(417) 269-2278
(417) 269-2274
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
076398
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190892
BLUE CROSS OF MO
—
05
—
428372809
—
MO
Enumeration date
09/26/2006
Last updated
05/07/2019
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