Individual
SUSAN ELIZABETH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM
Contact information
Practice address
5410 HILL CREST ST, RUSSELLVILLE, MO 65074-1213
(573) 230-6023
(573) 378-5295
Mailing address
5410 HILL CREST ST, RUSSELLVILLE, MO 65074-1213
(573) 230-6023
(573) 378-5295
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
09090028
MO
Other
Enumeration date
02/29/2012
Last updated
02/29/2012
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