Individual
ANDREA GAIL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1830 STATE HIGHWAY 9, DECORAH, IA 52101-7301
(563) 382-3140
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001466
IA
363AS0400X
Surgical Physician Assistant
Primary
001466
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33065
WELLMARK BCBS
IA
Enumeration date
08/22/2005
Last updated
05/15/2015
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