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Individual

MARGARET GRAY WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
12203 CORPORATE PKWY, MEQUON, WI 53092-3388
(262) 387-8200
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5152
WI
363AM0700X
Medical Physician Assistant
5152
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100158117
WI
Enumeration date
03/31/2020
Last updated
02/22/2024
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