Individual
ALEXANDER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA STUDENT
Contact information
Practice address
2855 CAMPUS DR, PLYMOUTH, MN 55441-2649
(763) 577-7160
(763) 577-7074
Mailing address
2829 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3230
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14807
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
11/21/2023
Last updated
02/07/2024
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