Individual
NANCY ELIZABETH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.
Contact information
Practice address
2500 COUNTY ROAD 42 W, STE 135, BURNSVILLE, MN 55337-6911
(952) 250-9952
Mailing address
2500 COUNTY ROAD 42 W, STE 135, BURNSVILLE, MN 55337-6911
(952) 250-9952
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3454
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
391225600
—
MN
Enumeration date
04/09/2007
Last updated
08/02/2019
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