Individual
BRETT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
541 STATE ROUTE 664 N, SUITE C, LOGAN, OH 43138-8541
(740) 385-6594
(740) 380-0852
Mailing address
1049 WESTERN AVE, P.O. BOX 188, CHILLICOTHE, OH 45601-1104
(740) 773-4366
(740) 775-7855
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
16225
OH
Other
Enumeration date
07/12/2014
Last updated
01/14/2015
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