Individual
CONNIE MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7173 E SUPER 1 LOOP STE B, ATHOL, ID 83801-7109
(208) 561-9901
(208) 561-9968
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854-5326
(208) 262-2498
(208) 262-7461
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1655A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619341260
—
ID
Enumeration date
11/19/2015
Last updated
03/25/2025
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