Individual
THERESA LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8118 GOOD LUCK RD, LANHAM, MD 20706-3574
(301) 552-8118
Mailing address
122 LAFAYETTE AVE, LAUREL, MD 20707-4512
(301) 498-5990
(301) 498-6576
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0001801
MD
Other
Enumeration date
07/27/2012
Last updated
09/04/2012
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