Individual
STACY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4233 PELICAN DR, FALLON, NV 89406-2445
(775) 291-8406
Mailing address
4233 PELICAN DR, FALLON, NV 89406-2445
(775) 291-8406
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
03/20/2012
Last updated
03/20/2012
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