Individual
MRS. EMILY ELIZA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1961 PREMIER DR, MANKATO, MN 56001-6492
(507) 387-2939
Mailing address
313 3RD ST W, JORDAN, MN 55352-1425
(612) 466-0922
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11985
MN
Other
Enumeration date
12/06/2015
Last updated
12/06/2015
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