Individual
MR. JOHN ZAAKERY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
3350 E BEECH WAY # A, WASILLA, AK 99654-7417
(760) 808-0251
Mailing address
300 N MAIN ST, WASILLA, AK 99654-7017
(907) 357-8780
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7005862
DRIVERS LICENSE
AK
Enumeration date
04/29/2019
Last updated
04/29/2019
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