Individual
DR. SHANNON B WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 GRESHAM DR, NORFOLK, VA 23507-1904
(757) 388-1141
(757) 388-1145
Mailing address
PO BOX 1980, NORFOLK, VA 23501-1980
(757) 388-1141
(757) 388-1145
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101267058
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2014
Last updated
05/08/2020
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