Individual
CLARA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(267) 588-5961
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT232523
PA
207RN0300X
Nephrology Physician
Primary
MD493698
PA
207RN0300X
Nephrology Physician
MT232523
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2021
Last updated
04/16/2026
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