Individual
PATRICIA ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNIM
Contact information
Practice address
1019 SAGEWOOD PL, POCATELLO, ID 83201-2729
(208) 221-0234
Mailing address
1019 SAGEWOOD PL, POCATELLO, ID 83201-2729
(208) 221-0234
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
713
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
713
CNIM
—
Enumeration date
08/12/2015
Last updated
08/12/2015
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