Individual
STEPHANIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1790 32 ND AVE SOUTH SUITE 1A, FARGO, ND 58104
(701) 492-3003
Mailing address
1790 32 ND AVE SOUTH SUITE 1A, FARGO, ND 58104
(701) 492-3003
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
376
ND
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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