Individual
CARMEN MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
725 CENTER AVE, MOORHEAD, MN 56560-1958
(507) 720-7775
(218) 287-1267
Mailing address
PO BOX 128, PILLAGER, MN 56473-0128
(507) 720-7775
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302876
MN
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
2467908
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1444799
MN DHS
MN
Enumeration date
02/23/2021
Last updated
02/23/2021
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