Individual
MARY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
704 W HISTORIC RT. 66, WAYNESVILLE, MO 65583
(573) 774-3121
(573) 774-2235
Mailing address
704 W HISTORIC RT. 66, WAYNESVILLE, MO 65459
(573) 774-3121
(573) 774-2235
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2002021037
MO
Other
Enumeration date
03/08/2017
Last updated
03/08/2017
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