Individual
ANNE JANETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1201 PACIFIC AVE STE 400, TACOMA, WA 98402-4381
(970) 402-7988
Mailing address
1449 RUNGE AVE, BLAINE, WA 98230-9507
(970) 402-7988
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
61224506
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61224506
STATE TEMPORARY LICENSE
WA
Enumeration date
09/16/2021
Last updated
09/16/2021
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