Individual
ANTHONY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4699
(260) 373-6727
Mailing address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4699
(260) 373-6727
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/24/2021
Last updated
05/02/2025
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