Individual
VANESSA JANE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 371-7999
Mailing address
86 GROVE ST APT B2, STAMFORD, CT 06901-1803
(818) 317-8377
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/31/2020
Last updated
12/31/2020
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