Individual
KATHLEEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9 HEALTHCARE DR STE 204, BIDDEFORD, ME 04005-9450
(207) 284-2630
Mailing address
315 S MANNING BLVD, ALBANY, NY 12208-1707
(518) 525-1693
(518) 275-4002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1433
ME
363AS0400X
Surgical Physician Assistant
0098561
NY
363AS0400X
Surgical Physician Assistant
Primary
PA1433
ME
Other
Enumeration date
08/25/2006
Last updated
04/01/2019
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