Individual
STEPHANIE CAROLINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1551 PROFESSIONAL LN, SUITE 220, LONGMONT, CO 80501-6972
(720) 279-9098
Mailing address
1551 PROFESSIONAL LN, SUITE 220, LONGMONT, CO 80501-6972
(720) 279-9098
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004711
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36125083
—
CO
Enumeration date
09/29/2016
Last updated
02/13/2017
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