Individual
NICHOLAS RICHARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8765 LEWIS AVE, TEMPERANCE, MI 48182-9583
(734) 847-3802
Mailing address
8765 LEWIS AVE, TEMPERANCE, MI 48182-9583
(734) 847-3802
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005306
MI
Other
Enumeration date
07/13/2006
Last updated
02/26/2014
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