Individual
BETHANY RENEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21448 S 465 RD, TAHLEQUAH, OK 74464-1048
(918) 457-6478
Mailing address
21448 S 465 RD, TAHLEQUAH, OK 74464-1048
(918) 457-6478
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/12/2024
Last updated
12/12/2024
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