Individual
MRS. CARLY ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
211 WALNUT BLVD, ROCHESTER, MI 48307-2056
(248) 413-5835
Mailing address
1944 BACON AVE, BERKLEY, MI 48072-1061
(248) 756-8753
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704307528NSA190PR
MI
Other
Enumeration date
10/02/2019
Last updated
12/05/2021
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