Individual
AMBER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 US ROUTE 66 W STE C, MORIARTY, NM 87035-1039
(505) 226-1566
(505) 521-5191
Mailing address
15 WOODPECKER LN, MORIARTY, NM 87035-5392
(505) 226-1460
(505) 521-5191
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/18/2026
Last updated
03/18/2026
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