Individual
LISA RUTH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
324 W 5TH ST, WASHINGTON, MO 63090-2306
(636) 795-0342
Mailing address
24776 STATE HIGHWAY EE, WARRENTON, MO 63383-5883
(636) 795-0342
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2014010130
MO
Other
Enumeration date
04/16/2014
Last updated
04/16/2014
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