Individual
MS. ANITA D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
11155 DUNN RD, DIV SURG UROLOGY, STE 202N, SAINT LOUIS, MO 63136-6150
(314) 362-8200
(314) 454-5244
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-8200
(314) 454-5244
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
126493
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427561212
—
MO
Enumeration date
07/17/2006
Last updated
04/17/2025
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