Individual
LORRAINE T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13901 MCAULEY BLVD, SUITE 303, OKLAHOMA CITY, OK 73134-8700
(405) 748-5800
Mailing address
13901 MCAULEY BLVD, SUITE 303, OKLAHOMA CITY, OK 73134-8700
(405) 748-5800
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
12390
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100136130A
—
OK
Enumeration date
09/05/2006
Last updated
09/21/2018
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