Individual
ANDREA LOIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9000 N MAIN STREET, SUITE 101, DAYTON, OH 45415
(937) 832-2425
(937) 832-9804
Mailing address
9000 N MAIN STREET, SUITE 101, DAYTON, OH 45415
(937) 832-2425
(937) 832-9804
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-001937
OH
363A00000X
Physician Assistant
50001937
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067865
—
OH
Enumeration date
12/19/2006
Last updated
08/18/2014
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