Individual
MR. GLENN GORDON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP(C)CO,BOCP
Contact information
Practice address
514 S WASHINGTON ST, SPOKANE, WA 99204-2620
(509) 624-3314
(509) 787-0952
Mailing address
4214 S SULLIVAN RD, VERADALE, WA 99037-9187
(406) 750-0123
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
PS60602304
WA
Other
Enumeration date
08/01/2017
Last updated
08/01/2017
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