Individual
DR. GINA SIMONE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D. ( MEDICAL DOCTO
Contact information
Practice address
340 9TH ST, FLORENCE, OR 97439-9470
(541) 902-1634
(541) 902-9702
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(541) 902-1634
(541) 902-9702
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
40235
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40235
STATE HEALTH LICENSE
TN
Enumeration date
09/02/2005
Last updated
03/10/2016
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