Individual
AMBER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
3072 SOURDOUGH TRL, SOUTH LAKE TAHOE, CA 96150-4553
(530) 600-0657
Mailing address
3072 SOURDOUGH TRL, SOUTH LAKE TAHOE, CA 96150-4553
(530) 600-0657
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1016466
CA
Other
Enumeration date
09/14/2010
Last updated
09/14/2010
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