Individual
TEICHA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2111 COLLEGE DR, REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, GALLUP, NM 87301-5600
(505) 863-1820
Mailing address
1901 REDROCK DR, PFS DEPT, GALLUP, NM 87301-5683
(505) 863-7000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD2004-0819
NM
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD60027915
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10019728
LOVELACE HEALTH/SALUD
NM
01
—
202000082
PRESBYTERIAN HEALTH/SALUD
NM
05
—
42378516
—
NM
05
—
953126
—
AZ
01
—
NM009W12
BCBS
NM
01
—
QMYPR0068268
MOLINA
—
Enumeration date
02/06/2006
Last updated
01/28/2014
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