Individual
GABRIEL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP-FAMILY
Contact information
Practice address
134 OWENSVILLE RD, WEST RIVER, MD 20778-9702
(410) 867-4700
Mailing address
6131 SHADY SIDE RD, SHADY SIDE, MD 20764-9504
(410) 867-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R225305
MD
Other
Enumeration date
11/04/2022
Last updated
11/04/2022
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