Individual
DIANA LORRAINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1209 E CUMBERLAND AVE, UNIT 2505, TAMPA, FL 33602-4256
(704) 575-8825
Mailing address
1209 E CUMBERLAND AVE, UNIT 2505, TAMPA, FL 33602-4256
(704) 575-8825
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
077328
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
239379
ANTHEM HEALTHKEEPERS
VA
Enumeration date
11/13/2006
Last updated
01/06/2017
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