Individual
MS. CALLIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
412 LILLY RD NE, OLYMPIA, WA 98506-5132
(360) 786-5581
Mailing address
3043 CENTRAL ST SE, OLYMPIA, WA 98501-3627
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP30000546
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DSHS9600255
—
WA
Enumeration date
05/01/2007
Last updated
07/18/2007
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