Individual
KELLY MAUREEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
303 SACRAMENTO ST, VALLEJO, CA 94590-5901
(925) 887-5398
Mailing address
1700 WEAVERLY DR, PETALUMA, CA 94954-3732
(510) 295-9765
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
11350
CA
Other
Enumeration date
05/09/2007
Last updated
05/14/2024
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