Individual
MRS. LISA M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
550 N HILLSIDE ST, WICHITA, KS 67214-4910
(316) 962-8580
(316) 962-8581
Mailing address
109 S ONEWOOD CIR, ANDOVER, KS 67002-8851
(316) 305-1160
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
45799
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161675
BCBS OF KANSAS
KS
05
—
200377070A
—
KS
Enumeration date
08/29/2006
Last updated
07/08/2007
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