Individual
MARYBETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P
Contact information
Practice address
550 E 1400 N, SUITE I, LOGAN, UT 84341-2406
(435) 753-1545
Mailing address
550 E 1400 N, SUITE I, LOGAN, UT 84341-2406
(435) 753-1545
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
6191957-4405
UT
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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