Individual
SHAWNEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
394.3 US-160, KAYENTA, AZ 86033
(928) 697-4000
Mailing address
PO BOX 405, ROCK POINT, AZ 86545-0405
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
1029958
NM
Other
Enumeration date
02/09/2021
Last updated
02/09/2021
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