Individual
LORI LYN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12700 SW 53RD ST, MUSTANG, OK 73064-7257
(405) 503-1073
Mailing address
12700 SW 53RD ST, MUSTANG, OK 73064-7257
(405) 503-1073
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/30/2020
Last updated
09/30/2020
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